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PUBLIC   HEALTH 
MANUAL 


Columbia  ©nibersitp 

in  tije  Citp  of  ^ettj  gorfe 

COLLEGE  OF  PHYSICIANS 
AND   SURGEONS 


Reference  Library 

Given  by 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/publichealthmanuOOnewy 


NEW  YOKK 
STATE  DEPARTMENT  OF  HEALTH 


Public  Health  Manual 


OFFICERS  OF  ADMINISTRATION 

THE  PUBLIC  HEALTH  LAWS 

RULES  FOR  SEWERAGE  SYSTEMS 

MODEL   SANITARY    REGULATIONS 

INSTRUCTIONS  TO    HEALTH    OFFICERS    AND 
REGISTRARS 

RULES  FOR  TRANSPORTATION  OF  THE  DEAD 

COMMUNICABLE  DISEASES  CIRCULARS 

WATER  ANALYSIS 


DIVISION   OF    PUBLICITY    AND    EDUCATION 

NEW  YORK   STATE   DEPARTMENT   OF   HEALTH 

ALBANY 

1911 


Krtlll./rS' 
•4  2^__ , , 

CONTENTS 


N^? 


PAGE 

OflBcers  of  Administration,  State  Department  of  Healtli 3 

Medical  Officers  of  the  State  Department  of  Health 4 

Public  Health  Law: 

State  Department  of  Health 5 

Local  Boards  of  Health 14 

Potable  Waters 37 

Miscellaneous  Provisions 52 

Vaccination  of  School  Children 53 

Institutions  for  Children 54 

Tuberculosis  Camps  and  Hospitals,  Sites 56 

Tuberculosis  Law 58 

County  Hospitals  for  Tuberculosis ' 67 

The  Penal  Law,  Crimes  against  Public  Health 77 

Village  Law,  Establishment  of  Sewers 79 

Town  Law,  Establishment  of  Sewers 88 

Sewerage  Systems,  B.ules  for  Plans. 100 

Village  Building  and  Sanitary  Code ■  ■  ■■ 107 

Model  Sanitary  Regulations 109 

Instructions  to  Health  OflBcers 128 

Instructions  to  Registrars 143 

Transportation  of  the  Dead,  Rules  for 146 

Tuberculosis,  Instructions  Regarding 153 

Typhoid  Fever,  Instructions  Regaraing 159 

Smallpox,  Instructions  Regarding 167 

Diphtheria,  Instructions  Regarding 175 

Cerebrospinal  Meningitis,  Instructions  Regarding 180 

Epidemic   Poliomyelitis 184 

Measles  and  Scarlet  Fever,  Instructions  Regarding 190 

Whooping  Cough,  Instructions  Regarding 196 

Ophthalmia  Neonatorum,  Instructions  Regarding 199 

Water  Analysis,  Conditions  for  Making 203 

Water  Examinations,  Scope  of,  in  Typhoid  Fever 204 


S         New  York  State  Department  of  Health 

Commissioner 
'^  EUGENE  H.  PORTER,  M.D. 

J)  


3  Division  of  Administration 

Deputy  Commissioner William  A.  Howe,  M.D. 

Secretary Alec   H.    Seymour 

Division  of  Sanitary  Engineering 

Chief  Engineer Theodore   Horton,   C.E, 

Principal  Assistant  Engineer H.  B.  Cleveland,  C.E. 

Special  Assistant  Engineer Prof.  H.  N.  Ogden,  C.E. 

Assistant  Sanitary  Engineer C.  A.  Holmquist,  C.E. 

Assistant  Engineer A.  O.  True,  C.E. 

Division  of  Laboratory  Work 

Director  State  Laboratories William  S.  Magill,  M.D. 

Chief  Sanitary  Chemist L.  M.  Wachter 

Water   Analyst L.    R.   Milford 

Assistant  Water  Analyst W.  S.  Davis 

Bacteriologist William  A.   Bing,   M.D. 

Director  Cancer  Laboratory H.  R.  Gay  lord,  M.D. 

Director  Bender  Laboratory Thomas  Ordway,  M.D. 

Division  of  Communicable  Diseases 
Director William  B.  May,  M.D. 

Division  of  Vital  Statistics 
Director F.   D.   Beagle 

Division  of  Publicity  and  Education 

Director Hills  Cole.  M.D. 

Director  Tuberculosis  Exhibition ..  Edward  G.  Whipple,  M.D. 

Consulting  Staff 

Dermatologist Frederic  C  Curtis,  M.D. 

Ophthalmologist Herbert   D.    Schenck,   M.D. 

Orthopedist Harlan  P.    Cole,   M.D. 

Laryngologist .Tohn  B.   Garrison,  M.D. 

Statistician Prof.  Walter  F.  Willcox,  Ph.D. 

Tuberculosis  Advisory  Board 

Edward  R.  Baldwin,  M.D Saranac  Lake 

Thomas  Darlington,  M.D New  York  City 

Livingston  Farrand,  M.D New  York  City 

Hon.  Homer  Folks,  Esq New  York  City 

Alfred   Meyer,    M.D New  York  City 

Prof.  Veranus  A.  Moore,  M.D Ithaca 

John   H.   Prvor,   M.D Buffalo 

William    H.    Watson,   M.D Utlca 

John  L.  Heffron,  M.D Syracuse 

3 


Medical  Officers  of  the  State  Department  of  Health 

F.  W.  Adkiance,  M.D 306  Lake  St..  Elmira,  N.  T. 

W.  D.  Alsever,  M.D 528  S.  Salina  St.,  Syracuse,  N.Y. 

F.  D.  Andrew,  M.D Sodus,  N.  Y. 

Charles  E.  Birch,  M.D...    White  Plains,  N.  Y. 

M.   Cavana,  M.D Sylvan  Beach.  N.  Y. 

♦Edward   Clark,   M.D 571   Ellicott  Sq.,  Buffalo,  N.  Y. 

W.  H.  CoxxELLY,  M.D 98  Fair  St.,  Kingston,  N.  Y. 

JH.  H.   Crum,  M.D 116  E.  State  St.,  Ithaca,  N.  Y. 

*F.  C.  Curtis,  M.D Washington  Av.,  Albany,  N.  Y. 

JZ.  F.  DuxxiXG,  M.D Philmont,-  N.  Y. 

♦Franklin  D.  Earl,  M.D...    41   Hamilton   St.,   Ogdensburg, 

N.    Y. 

H.  A.  Eastman,  M.D 208  Lafayette  St.,  Jamestown, 

N.   Y. 
♦George  M.  Fisher,  M.D...    230  Genesee   St.,  Utica,  N.  Y. 

W.  S.  Gaensey,  M.D 93    N.    Main    St.,    Gloversville, 

N.   Y. 
John  B.  Garrison,  M.D. . .    616   Madison   Av.,    New    York 

City. 
*1WILLIAM  B.  Gibson,  M.D.    Masonic    Temple,  Huntington, 

N.   Y. 
JCharles  H.  Glidden,  M.D.    31  N.  Ann  St.,  Little  Falls,  N.Y. 
JO.   J.    Hallenbeck,    M.D...    Canandaigua,   N.  Y. 
De  Yere  M.  Hibbard,  M.  D.    128  S.   Union  St.,  Olean,  N.  Y. 

John  B.  Huber 441  Park  Ave.,  New  York  City, 

Edward  H.   Hltton,  M.D.  .    154  Pine  St.,  Corning,  N.  Y. 

J  A.    D.   Lake,   M.D Gowanda,  N.  Y. 

J.  W.  Le  Seur,  M.D 207  E.  Main  St.,  Batavia,  N.  Y. 

Frederick  J.  Mann,  M.D..    262    Main    St.,    Poughkeepsie, 

N.   Y. 

JPerley  H.  Mason,  M.D 734  South  St..  Peekskill,  N.  Y. 

Blbt  J.  Maycock,  M.D.  .  .  .    560    Delaware    Ave.,    Buffalo, 

N.   Y. 

H.  E.  Merriam,  M.D 224  E.  State  St.,  Ithaca,  N.Y. 

George  W.  Miles,  M.D.  ...    11    Washington    Ave.,    Oneida, 

N.   Y. 
Douglas  C.  Moriarta,  M.D.   511        Broadway,        Saratoga 

Springs,  N.  Y. 

C.  F.  Ormes,  M.D 318  Main  St.,  Jamestown,  N.  Y. 

F.  A.  Palmer,  M.D Mechanicville,   N.  Y. 

*0.  W.  Peck,  M.D.  .  . 34     Watkins     Ave.,     Oneonta, 

N.   Y. 

Joseph  Roby,  M.D 52  S.  Fitzhugh  St.,  Rochester, 

N.   Y. 

B.  W.    Sherwood,  M.D 1117    S.    Salina   St.,   Syracuse, 

N.   Y. 
George  E.   Swift.  M.D.  .  .  .    314  Warren  St.,  Hudson,  N.  Y. 

W.  C.  Thompson,  M.D 2  Brinkerhoff  St.,  Plattsburgh, 

N.   Y. 

*tD.  M.  ToTMAN,  M.D Citv  Hall.   Syracuse,  N.  Y. 

*JA.  G.  Wilding,  M.D Malone,  N.  Y. 

*tE.  S.  WiLLARD,  M.D 17     Paddock     Arcade,     Water- 
town,  N.  Y. 
Uohn  S.  Wilson,  M.D 22    S.    Hamilton    St.,    Pough- 
keepsie,  N.   Y. 

E.  H.  WOLCOTT,  M.D 57    S.    Union    St.,    Rochester, 

N.   Y. 

tH.  L.  Wheeler,  D.D.S 12  W.  46th  St.,  New  York  City 

tW.  A.  White,  D.D.S Phelps,  N.  Y. 

♦  Smallpox  experts. 

tLecturers  and  consultants  on  oral  hygiene. 

JAIso  health  officers. 


PUBLIC  HEALTH  LAW 

ARTICLE  I 

Short  Title 

Section  1.  Short  Title. —  This  chapter  shall  be  known 
as  the  "  Public  Health  Law." 

*  ARTICLE  II 

State  Department  of  Health 

Section    2.  State  department  of  health. 

3.  Compensation  of  officers  and  employees. 

4.  General  powers  and  duties  of  commissioner. 

5.  Duties  with  respect  to  vital  statistics. 

6.  Nuisances. 

7.  Overflow  of  water   from  the  canals. 

8.  Employment  of   local  boards  and  experts. 

9.  Examination  and  inspection  of  public  works. 

10.  Acquisition  of  land. 

11.  Power    of   commissioner   where   municipality 

fails  to  establish  board  of  health. 

12.  Annual  report. 

13.  Tenement  houses  in  cities  of  the  first  class. 

14.  Approval  of  plans  for  certain  works  built  by 

state. 

15.  State  board  of  health  to  mean  department  of 

health. 

16.  Pending  actions  and  proceedings  not  affected. 

§  2.  State  department  of  health. —  The  state  depart- 
ment of  health  and  the  office  of  commissioner  of  health 
are  continued.     The  commissioner  of  health  shall  be  the 


O  THE  PUBLIC  HEALTH  LAW 

head  of  such  department.  Such  commissioner  shall  be 
appointed  by  the  governor,  by  and  with  the  advice  and 
consent  of  the  senate,  and  shall  be  a  physician,  a  gradu- 
ate of  an  incorporated  medical  college,  of  at  least  ten 
years'  experience  in  the  actual  practice  of  his  profes- 
sion, and  of  skill  and  experience  in  public  health  duties 
and  sanitary  science.  The  term  of  office  of  the  com- 
missioner shall  be  four  years,  beginning  on  the  first  day 
of  January  of  the  year  in  which  he  is  appointed. 

§  3.   Compensation   of  officers   and   employees. —  The 

commissioner  of  health  shall  receive  an  annual  salary 
of  three  thousand  five  hundred  dollars,  and  his  expenses 
actually  and  necessarily  incurred  in  the  performance  of 
his  official  duties,  to  be  paid  monthly  on  the  audit  of 
the  comptroller.  He  may  employ  such  clerical  and  other 
assistants  as  are  necessary  for  the  proper  performance 
of  the  powers  and  duties  of  the  department,  and  fix 
their  compensation  within  the  amount  appropriated 
therefor  by  the  legislature.  He  shall  designate,  in  writ- 
ing, one  of  his  assistants  who  shall  possess  the  powers 
and  perform  the  duties  of  commissioner  of  health  during 
his  absence  or  inability  to  act,  or  during  a  vacancy  in 
the  office. 

§  4.  General  powers  and  duties  of  commissioner. — 
The  commissioner  of  health  shall  take  cognizance  of  the 
interests  of  health  and  life  of  the  people  of  the  state, 
and  of  all  matters  pertaining  thereto.  He  shall  make 
inquiries  in  respect  to  the  cause  of  disease,  especially 
epidemics,  and  investigate  the  source  of  mortality,  and 
the  effect  of  localities,  employments  and  other  conditions, 
upon  the  public  health.  He  shall  obtain,  collect  and 
preserve  such  information  relating  to  mortality,  disease 
and  health  as  may  be  useful  in  the  discharge  of  his 
duties  or  may  contribute  to  the  promotion  of  health  or 


STATE   DEPAETMEXT    OF   HEALTH  7 

the  security  of  life  in  the  state.  He  may  issue  su^ 
poenas,  compel  the  attendance  of  witnesses  and  compel 
them  to  testify  in  any  matter  or  proceeding  before  him, 
and  a  ^vitness  may  be  required  to  att-end  and  give  testi- 
mony in  a  county  where  he  resides  or  has  a  place  of 
business  without  the  payment  of  any  fees.  The  com- 
missioner of  health  may  reverse  or  modify  an  order, 
regulation,  by-law  or  ordinance  of  a  local  board  of 
health  concerning  a  matter  which  in  his  judgment 
affects  the  public  health  beyond  the  territory  over  which 
such  local  board  has  jurisdiction;  and  may  exercise 
exclusive  jurisdiction  over  all  lands  acquired  by  the 
state  for  sanitary  purposes.  The  commissioner  of  health 
and  any  person  authorized  by  him  so  to  do,  may,  Avith- 
out  fee  or  hindrance,  enter,  examine  and  survey  all 
grounds,  erections,  vehicles,  structures,  apartments, 
buildings  and  places. 

§  5.  Duties  with  respect  to  vital  statistics. —  There 
shall  be  in  the  state  department  of  health  a  bureau  of 
vital  statistics  for  the  registration  of  births,  marriages, 
deaths  and  prevalent  diseases,  which  shall  be  under  the 
general  charge  and  supervision  of  the  commissioner  of 
health.  He  shall  prescribe  and  prepare  the  necessary 
methods  and  forms  for  obtaining  and  preserving  such 
statistics,  and  to  insure  the  prompt  and  faithful  regis- 
tration of  the  same  in  the  several  municipalities  and  in 
the  state  bureau.  He  shall  from  time  to  time  recom- 
mend such  forms  and  such  amendments  of  law  as  shall 
be  deemed  necessary  for  the  thorough  organization  and 
efficiency  of  registration  of  vital  statistics  throughout 
the  state,  as  supervised  by  him.  The  clerical  duties  and 
safekeeping  of  the  state  bureau  shall  be  provided  for 
by  the  commissioner  of  health.  The  comptroller  shall 
provide  and  furnish  such  stationery  as  the  commissioner 
may  require  in  the  discharge  of  his  duties.     If  defects 


8  '  THE   PUBLIC    HEALTH   LAW 

exist  in  any  registration  under  the  supervision  of  a  local 
board  of  health,  the  commissioner  shall  notify  the  local 
board  that  such  defects  must  be  amended  and  prevented 
Avithin  ten  days  from  the  date  of  the  notice.  If  such  de- 
fects are  not  so  amended  or  prevented,  the  commissioner 
shall  take  control  of  such  registration  and  the  record 
thereof,  and  enforce  the  rules  and  regulations  in  regard 
thereto,  and  secure  a  complete  registration  in  such 
municipality,  and  such  control  shall  continue  until  the 
local  board  satisfies  the  commissioner  that  it  will  make 
such  record  and  registry  complete,  as  required  by  law, 
and  the  expenses  incurred  bj"  the  commissioner  or  his 
representative  while  in  control  of  the  registration  shall 
be  a  charge  upon  the  municipality.  A  copy  of  any 
record  or  registry  in  the  office  of  the  state  department 
of  health,  duly  certified  by  the  commissioner  to  be  a 
true  copy  thereof,  shall  be  j)resumptive  evidence  in  all 
courts  and  places  of  the  facts  therein  stated.  The  com- 
missioner of  health  shall  prescribe  and  prepare  the 
necessary  methcds,  forms  and  rules  regulating  the  issue 
of  transfer  permits,  by  local  boards  of  health,  for  the 
transportation  of  corpses  for  burial  outside  of  the 
county  where  death  occurred  and  the  use  of  such  per- 
mits. He  shall  require  a  coupon  to  be  attached  to  every 
such  permit  to  be  detached  and  preserved  by  every  com- 
mon carrier,  or  person  in  charge  of  any  vessel,  car  or 
vehicle,  to  whom  any  such  corpse  shall  be  delivered  for 
transportation. 

§  6.  Nuisances. —  The  commissioner  of  health  shall 
have  all  necessary  powers  to  make  examinations  into 
nuisances,  or  questions  affecting  the  security  of  life 
and  health  in  any  locality.  Whenever  required  by  the 
governor  of  the  state,  he  shall  make  such  an  examina- 
tion and  shall  report  the  results  thereof  to  the  gov- 
ernor, within  the  time  prescribed  by  him  therefor.     The 


STATE  DEPABTMENT   OF  HEALTH  9 

report  of  every  such  examination,  wlien  approved  by  the 
governor,  shall  be  filed  in  the  office  of  the  secretary  of 
state,  and  the  governor  may  declare  the  matters  public 
nuisances,  which  may  be  found  and  certified  in  any  such 
report  to  be  nuisances,  and  may  order  them  to  be 
changed,  abated  or  removed  as  he  may  direct.  Every 
such  order  shall  be  presumptive  evidence  of  the  existence 
of  such  nuisance;  and  the  governor  may,  by  a  precept 
under  his  hand  and  official  seal,  require  the  district  at- 
torney, sheriff  and  other  officers  of  the  county  where 
such  nuisance  is  maintained,  to  take  all  necessary 
measures  to  execute  such  order  and  cause  it  to  be 
obeyed,  and  the  acts  of  any  such  county  officer  in  the 
abatement  of  any  such  nuisance,  reasonable  or  necessary 
for  such  abatement,  shall  be  lawful  and  justifiable  and 
the  order  of  the  governor  a  sufficient  protection  to  such 
officer.  The  expense  of  such  abatement  shall  be  paid 
by  the  municipality  where  the  nuisance  occurs,  and  shall 
be  a  debt  recoverable  by  such  municipality  of  all  per- 
sons, maintaining  it  or  assisting  in  its  maintenance, 
and  a  lien  and  charge  upon  the  lands  upon  which  the 
nuisance  is  maintained,  which  may  be  enforced  by  a 
sale  of  such  lands  to  satisfy  the  same. 

-§  7.  Overflow  of  water  from  the  canals. —  Whenever 
water  escaping  or  discharged  from  any  of  the  canals  of 
the  state,  through  water  gates,  spillways  or  otherwise, 
shall  overflow  adjacent  lands,  or  any  creek  or  stream 
receiving  such  waters,  or  collect  in  stagnant  pools  along 
the  canal  or  any  such  creek  or  stream  to  such  an  extent 
as  to  cause  disease  or  sickness  to  the  inhabitants  of  the 
vicinity,  any  three  of  such  inhabitants  may  make  a 
written  complaint  thereof  under  oath  to  the  commis- 
sioner of  health,  setting  forth  the  extent  of  the  injury 
to  the  public  health,  so  far  as  is  within  their  knowledge, 
and  the  length  of  time  the  disease  or  sickness  has  ex- 


10  THE  PUBLIC  HEAXTH   LAW 

ist^d,  "whicli  shall  be  accompanied  by  a  verified  certifi- 
cate of  a  practicing  physician  of  the  vicinity,  stating 
the  facts  known  to  him,  pertaining  to  the  allegations 
of  the  complaint.  Upon  receipt  of  such  complaint,  the 
commissioner  of  health  shall  forthwith  examine  into 
the  facts  and  circumstances  therein  set  forth,  and  may 
call  on  the  state  engineer  to  make  such  surveys  as  they 
may  require  for  their  information,  who  shall  make  the 
same  without  delay,  and  if  such  commissioner  is  satis- 
fied that  such  disease  or  sickness  exists,  and  is  caused 
by  waters  of  the  canal  escaping  or  discharged  therefrom, 
he  shall  so  report  to  the  superintendent  of  public  works, 
without  unnecessary  delay,  who  shall  forthwith  abate 
the  cause  of  such  disease  or  sickness. 

§  8.  Employment  of  local  boards  and  experts. —  When- 
ever requested  by  the  commissioner  of  health,  any  city 
board  of  health  in  this  state  may  appoint  one  of  its 
members  to  act  with  and  assist  the  commissioner  dur- 
ing the  examination  of  any  nuisance,  or  for  the  pur- 
pose of  determining  whether  a  public  nuisance  exists. 
Such  representative  may  take  part  in  such  examination, 
and  sit  with  the  commissioner  during  the  conduct 
thereof,  but  the  final  determination  of  the  questions 
involved  shall  rest  solely  with  the  commissioner.  The 
commissioner  may  from  time  to  time  employ  competent 
persons  to  render  sanitary,  service,  and  make  or  super- 
vise practical  and  scientific  investigations  and  examina- 
tions requiring  expert  skill,  and  prepare  plans  and  re- 
ports relative  thereto. 

§  9.  Examination  and  inspection  of  public  works. — 

All  persons  having  the  control,  charge  or  custody  of  any 
public  structure,  work  or  ground,  or  of  any  plan,  de- 
scription, outline,  drawing  or  chart  thereof  or  relating 
thereto,  made,  kept  or  controlled  by  or  under  any  public 


STATE  DEPAETilEXT   OF   HEALTH  11 

authority,  shall  permit  and  facilitate  the  examination, 
inspection  and  copying  thereof  by  the  commissioner  of 
healtli,  or  by  any  person  authorized  by  him  to  make 
such  examination  or  inspection  or  such  copies. 

§  10,  Acquisition  of  land. —  If  the  commissioner  of 
health  or  the  health  oflBcer  of  the  port  of  Xew  York 
shall  certify  to  the  commissioners  of  the  land  office  that 
by  reason  of  sudden  emergency  the  acquisition  of  any 
land  is  immediately  necessary  for  quarantine  or  other 
purposes  to  prevent  great  danger  to  the  public  health, 
and  such  commissioners  are  satisfied  that  such  action 
is  necessary,  such  commissioners  may  acquire  by  pur- 
chase or  by  condemnation,  in  the  name  of  the  people 
of  the  state  of  Xew  York,  such  land  as  in  their  judg- 
ment is  necessary  and  suitable  for  such  purposes. 

§  11.  Power  of  commissioner  where  municipality  fails 
to  establish  board  of  health. —  If  any  municipal  cor- 
poration, authorized  by  law  to  establish  a  local  board 
of  health,  shall  omit  to  do  so,  the  commissioner  of 
health  may,  in  such  municipality,  exercise  the  powers 
of  a  local  board  of  health  and  appoint  a  health  officer 
thereof  and  fi:s  his  duties  and  compensation.  The  com- 
pensation of  such  health  officer  and  the  expenses  law- 
fully incurred  by  him  and  by  the  commissioner  of  health 
in  such  municipality  shall  be  a  charge  upon  and  paid 
by  such  municipality  until  such  time  as  a  local  board 
of  health  shall  be  established  therein,  whereupon  the 
jurisdiction  of  such  health  officer  and  of  the  commis- 
sioner of  health  conferred  by  this  section  shall  cease. 

§  12.  Annual  report. —  The  commissioner  of  health 
shall  annually,  on  or  before  the  first  Monday  in  Feb- 
ruary, make  a  written  report  to  the  governor  upon  the 
vital  statistics  and  sanitary  conditions  and  prospects  of 


12  THE  PUBLIC  HEALTH  LAW 

the  state.  Such  reports  shall  set  forth  the  action  of  the 
department  and  of  its  officers  and  agents  and  the  names 
thereof  during  the  past  year,  a  detailed  statement  of  all 
moneys  paid  out  by  or  on  account  of  the  department, 
and  the  manner  of  its  expenditure  during  the  year,  and 
other  useful  information,  and  shall  suggest  any  further 
legislative  action  or  precaution  deemed  necessary  for 
the  better  protection  of  life  and  health. 

§  13,  Tenement  houses  in  cities  of  the  first  class. — 
The  commissioner  shall  have  power  to  examine  into  the 
enforcement  of  the  laws  relating  to  tenement  houses  in 
any  city  of  the  first  class.  Whenever  required  by  the 
governor,  he  shall  make  such  an  examination  and  shall 
report  the  results  thereof  to  the  governor  within  the 
time  prescribed  by  him  therefor. 

§  14.  Approval  of  plans  for  certain  works  built  by 
state  and  inspection  of  state  institutions  by  state  com- 
missioner of  health. —  In  all  buildings  and  institu- 
tions, owTied,  maintained  or  controlled  by  the  state,  the 
plans  for  all  water  supply,  sewerage,  sewage-disposal 
and  garbage-disposal  works,  shall  be  subject  to  the  ap- 
proval of  the  state  commissioner  of  health  before  being 
adopted  or  constructed.  Whenever  required  by  the  fiscal 
supervisor  of  state  charities,  the  state  commissioner  of 
health  shall  make  an  examination  and  inspection  of  the 
sanitary  conditions  of  such  institutions  as  report  to  the 
fiscal  supervisor  of  state  charities  and  transmit  copies 
of  his  report  and  recommendations  thereon  to  the  presi- 
dent of  the  board  of  managers  or  trustees  of  such  insti- 
tution and  to  the  fiscal  supervisor  of  state  charities. 
It  shall  be  the  duty  of  the  superintendents  of  said  insti- 
tutions to  immediately  report  an  outbreak  of  a  con- 
tagious or  infectious  disease  to  the  state  commissioner 
of  health,  and  upon  receipt  of  such  report  the  state 
commissioner  of  health  shall  advise  the  superintendent 


STATE   DEPARTiIE^'T    OF   HEALTH  13 

of  said  institution  as  to  the  best  means  to  effectually 
control  said  disease.  It  shall  be  the  duty  of  the  state 
commissioner  of  health  to  make  regular  analyses  of  the 
water  supplies  of  said  institutions,  at  least  twice  in  each 
year,  and  furnish  copies  of  his  reports  thereon  to  the 
president  of  the  board  of  managers  or  trustees  of  the 
institutions,  and  to  the  fiscal  supervisor  of  state 
charities. 

§  1.5.  State  board  of  health  to  mean  department  of 
health. — "Wheuever  the  term  "  state  board  of  health " 
occurs  or  any  reference  is  made  thereto,  in  any  law,  it 
shall  be  deemed  to  mean  or  refer  to  the  department  of 
health  as  described  in  this  article.  The  commissioner  of 
health  shall  have  all  the  powers  conferred  and  perform 
all  the  duties  imposed  by  law  upon  the  state  board  of 
health,  or  any  member,  com^mittee  or  officer  thereof,  in- 
eluding  the  secretary. 

§  16.  Pending  actions  and  proceedings  not  affected. — 
This  article  shall  not  affect  actions  or  proceedings,  civil 
or  criminal,  brought  by  or  against  the  state  board  of 
health,  and  pending  on  February  nineteenth,  nineteen 
hundred  and  one,  but  such  actions  or  proceedings  may 
be  prosecuted  or  defended  in  the  same  manner  and  to 
the  same  effect  by  the  commissioner  of  health  as  if  the 
foregoing  provisions  had  not  taken  effect.  Xor  shall 
any  of  the  foregoing  provisions  affect  in  any  manner 
any  order  or  recommendation  made  by,  or  any  other 
matters  or  proceedings  before  such  state  board  of  health, 
and  all  such  matters  and  proceedings  pending  before 
such  board  on  the  above  date  shall  be  continued  before 
the  commissioner  of  health. 


14  THE  PUBLIC  HEALTH  LAW 

ARTICLE  III 
Local  Boards  of  Health 

Section  20.  Local  boards  of  health. 

21.  General  powers  and  duties  of  local  boards  of 

health. 

22.  Vital  statistics. 

23.  Burials  and  burial  permits. 

24.  Regulating  interments  in  cemeteries. 

25.  Infectious   and   contagious  or   communicable 

diseases. 

26.  Xuisances. 

27.  Owner  to  bear  all  or  part  of  expense  of  re- 

moval. 

28.  Assessing  cost  on  property  benefited. 

29.  Municipality  may  bear  part  of  expense. 

30.  Assessing  expense  upon  property  benefited. 

31.  Removal  of  nuisances. 

32.  Expense   of    abatement  of   nuisances   a   lien 

upon  the  premises. 

33.  Manufactures  in  tenement  houses  and  dwel- 

lings. 

34.  Jurisdiction  of  town  and  callage  boards. 

35.  Expenses,  how  paid. 

36.  Relief   of   indigent   Indians    in   case    of   epi- 

demic. 

37.  Mandamus. 

38.  Exceptions   and    limitations    as   to   cities   of 

^New  York,  Brooklyn,  Buffalo,  Albany  and 
Yonkers. 

39.  Certain  kinds  of  business  and  manufacture 

prohibited  in  cities  or  within  three  miles 
therefrom ;   exceptions. 

§  20.  Local  boards  of  health. —  There  shall  continue 
to  be  local  boards  of  health  and  health  officers  in  the 


LOCAL  BOAEDS  OF  HEALTH  15 

several  cities,  villages  and  toTvns  of  the  state.  In  the 
cities,  except  cities  of  the  first  and  second  class,  the 
board  shall  consist  of  the  mavor  of  the  city  who  shall 
be  its  president,  aaid  at  least  sis  other  persons,  one  of 
whom  shall  be  a  competent  physician,  who  shall  be  ap- 
pointed by  the  common  council,  upon  the  nomination  of 
the  mayor,  and  shall  hold  ofiice  for  three  years.  Ap- 
pointments of  members  of  such  boards  shall  be  made 
for  such  shorter  terms  as  at  any  time  may  be  necessary, 
in  order  that  the  terms  of  two  appointed  members  shall 
expire  annually.  In  the  cities,  except  cities  of  the  first 
and  second  class, .  and  such  other  cities  whose  charters 
otherwise  provide,  the  board  shall  appoint,  for  a  term 
of  four  years,  a  competent  physician,  not  one  of  its 
members,  to  be  the  health  officer  of  the  city,  and  shall 
fill  any  vacancy  that  now  exists  or  may  hereafter  exist 
from  expiration  of  term  or  otherwise  in  the  office  of 
health  officer  of  the  city.  In  villages  the  board  shall 
consist  of  not  less  than  three  nor  more  than  seven  per- 
sons, not  trustees  of  the  village,  who  shall  be  appointed 
by  the  board  of  trustees  at  the  first  meeting  of  the 
board  of  trustees  of  such  village,  after  the  next  annual 
election  of  the  village;  the  members  of  said  board  of 
health  shall  at  their  first  meeting  divide  themselves 
by  lot  into  three  classes,  whose  terms  of  office  shall  ex- 
pire respectively  in  one,  two  and  three  years,  from  the 
annual  election  held  prior  to  their  appointment; 
and  in  case  of  an  increase  in  the  membership  of  such 
board,  as  hereinafter  provided,  there  shall  be  a  like 
apportionment  by  lot,  of  the  added  members,  in  respect 
to  their  terms  of  office,  at  the  first  meeting  of  said 
board  after  such  increase  occurs,  whereby  the  whole 
number  of  terms  expiring  annually  shall  be  as  nearly 
equal  as  possible.  From  and  after  the  appointment  of 
said  board  as  above  provided,  the  appointment  of  the  suc- 
cessors of  said  members  shall  be  made  immediatelv  after 


16  THE   PUBLIC    HEALTH    LAW 

the  annual  elections  of  said  village  and  shall  continue  in 
office  until  their  successors  are  appointed  unless  removed 
therefrom;  provided,  however,  that  upon  failure  to  ap- 
point such  board  of  health  at  such  first  meeting  such 
appointment  may  be  made  at  any  subsequent  meeting,, 
in  the  event  of  no  aj)pointment  having  been  made  by 
the  proper  authorities  as  hereinafter  provided.  The 
board  of  trustees  of  such  village  may,  in  its  discretion, 
at  the  first  meeting  of  such  board  held  after  any  annual 
election  of  the  village,  increase  the  number  of  members 
of  the  board  of  health  of  such  village,  and  appoint  such 
additional  members  and  thereafter  appoint  their  suc- 
cessors, providing  the  number  of  members  of  such  board 
of  health,  as  increased,  shall  not  exceed  seven.  Every 
such  village  board  shall  elect  a  president  and  secretary, 
the  president  to  be  elected  from  among  the  members 
of  said  board.  In  towns  the  board  of  health  shall  con- 
sist of  the  town  board  and  another  citizen  of  the  town 
of  full  age  biennially  appointed  by  the  town  board  at  a 
meeting  thereof  after  each  biennial  to\vn  meeting  for 
the  term  of  two  years  from  and  after  such  town  meet- 
ing and  until  his  successor  is  appointed.  The  local 
board  of  health  shall  appoint  a  competent  physician, 
not  a  member  of  the  local  board  of  health,  to  be  the 
health  officer  of  the  municipality.  The  term  of  office 
of  the  health  officer  shall  be  four  years  and  he  shall 
hold  office  until  the  appointment  of  his  successor.  He 
may  be  removed  for  just  cause  by  the  local  board  of 
health  or  the  state  commissioner  of  health  after  a  hear- 
ing; such  removal  by  the  local  board  of  health  must  be 
approved  by  the  state  commissioner  of  health.  The 
health  officer  need  not  reside  within  the  village  or  town 
for  which  he  shall  be  chosen,  but  unless  he  shall,  he 
must  reside  in  an  adjoining  town.  If  the  proper  au- 
thorities shall  not  fill  any  vacancies  occurring  in  the 
membership  of  any  local  board  within  thirty  days  after 


LOCAL  EOAKDS  OF  HEALTH  17 

the  happening  of  such  vacancy,  the  mayor  of  the  city, 
president  of  the  village,  or  supervisor  of  the  town,  shall 
appoint  a  competent  person  to  fill  the  vacancy  for  the 
unexpired  term,  which  appointment  shall  be  immediately 
filed  in  the  office  of  the  county  clerk,  and  a  duplicate 
thereof  filed  with  the  clerk  of  the  municipality  for  which 
such  appointment  is  made.  Xotice  of  the  membership 
and  organization  of  every  Iccal  board  of  health  shall 
be  forthwith  given  by  such  board  to  the  state  depart- 
ment of  health.  The  term  ""'  municipality.""  when  used 
in  this  article,  means  the  city,  village  or  to\^n  for  which 
any  such  local  board  may  be  or  is  appointed.  The  pro- 
visions herein  contained  for  the  appointment  and  num- 
ber of  members  of  boards  of  health,  and  for  the  appoint- 
ment of  health  officers,  shall  apply  to  all  towns  and  vil- 
lages, whether  such  villages  are  organized  under  general 
or  special  laws. 

§  21.  General  powers  and  duties  of  local  boards  of 
health. —  Every  such  local  board  of  health  shall  meet 
at  stated  intervals  to  be  fixed  by  it,  in  the  mtmicipality. 
The  presiding  officer  of  every  such  board  may  call 
special  meetings  thereof  when  in  his  judgment  the  pro- 
tection of  the  public  health  of  the  mtmicipality  reqtiires 
it,  and  he  shall  call  such  meeting  upon  the  petition  of 
at  least  twenty-five  residents  thereof,  of  full  age.  setting 
forth  the  necessity  of  stich  meeting.  Every  such  local 
board  shall  prescribe  the  duties  and  powers  of  the  local 
health  officer,  who  shall  be  its  ^hief  executive  officer, 
and  direct  him  in  the  performance  of  his  duties,  and 
fix  his  compensation.  In  addition  to  his  compensation 
so  fixed,  the  board  of  health  must  allow  the  actual  and 
reasonable  expenses  of  said  health  officer  in  going  to, 
attending  and  returning  from,  the  annual  sanitary  con- 
ference of  health  officers,  or  equivalent  meeting,  held 
2 


18  THE  PUBLIC   HEALTH   LAW 

yearly  within  the  state,  and  whenever  the  services  ren- 
dered by  its  health  officer  shall  include  the  care  of  small- 
pox, the  board  of  health  shall  allow,  or  whenever  such 
services  are  extraordinary,  by  reason  of  infectious  dis- 
eases, or  otherwise,  they  may  in  their  discretion,  allow 
to  him  such  further  sum  in  addition  to  said  fixed  com- 
pensation as  shall  be  adequate  for  such  services,  audited 
by  the  town  board  of  a  town,  by  the  board  of  trustees 
of  a  village  or  by  the  proper  auditing  board  of  a  city 
of  the  third  class,  which  said  expenses  and  said  addi- 
tional compensation  shall  be  a  charge  upon  and  paid 
by  the  municipality  as  provided  in  section  thirty-five 
of  this  chapter.  Every  such  local  board  shall  make  and 
publish  from  time  to  time  all  such  orders  and  regula- 
tions as  they  may  deem  necessary  and  proper  for  the 
preservation  of  life  and  health,  and  the  execution  and 
enforcement  of  this  chapter  in  the  municipality.  It 
shall  make  without  publication  thereof,  such  orders  and 
regulations  for  the  suppression  of  nuisances,  and  con- 
cerning all  other  matters  in  its  judgment  detrimental 
to  the  public  health  in  special  or  individual  cases,  not 
of  general  application,  and  serve  copies  thereof  upon 
the  owner  or  occupant  of  any  premises  whereon  such 
nuisances  or  other  matters  may  exist,  or  upon  which 
may  exist  the  cause  of  other  nuisances  to  other  prem- 
ises, or  cause  the  same  to  be  conspicuously  posted 
thereon.  It  may  employ  such  persons  as  shall  be  neces- 
sary to  enable  it  to  carry  into  effect  its  orders  and  regu- 
lations, and  fix  their  compensation.  It  may  issue  sub- 
poenas, compel  the  attendance  of  witnesses,  administer 
oaths  to  witnesses  and  compel  them  to  testify,  and  for 
such  purposes  it  shall  have  the  same  powers  as  a  justice 
of  the  peace  of  the  state  in  a  civil  action  of  which  he 
has  jurisdiction.  It  may  designate  by  resolution  one 
of  its  members  to  sign  and  issue  such  subpoenas.  No 
subpoena  shall  be  served  outside  the  jurisdiction  of  the 


LOCAL  BOARDS  OF  HEALTH  19 

board  issuing  it,  and  no  witness  shall  be  interrogated 
or  compelled  to  testify  upon  matters  not  related  to  tbe 
public  health..  It  may  issue  warrants  to  any  constable 
or  policeman  of  the  municipality  to  apprehend  and  re- 
move such  persons  as  cannot  otherwise  be  subjected  to 
its  orders  or  regulations,  and  a  warrant  to  the  sheriff 
of  the  county  to  bring  to  its  aid  the  power  of  the  county 
whenever  it  shall  be  necessary  to  do  so.  Every  warrant 
shall  be  forthwith  executed  by  the  officer  to  whom 
directed,  who  shall  have  the  same  powers  and  be  subject 
to  the  same  duties  in  the  execution  thereof,  as  if  it  had 
been  duly  issued  out  of  a  court  of  record  of  the  state. 
Every  such  local  board  may  prescribe  and  impose  penal- 
ties for  the  violation  of  or  failure  to  comply  with  any 
of  its  orders  or  regulations,  not  exceeding  one  hundred 
dollars  for  a  single  violation  or  failure,  to  be  sued  for 
and  recovered  by  it  in  the  name  and  for  the  benefit  of 
the  municipality;  and  may  maintain  actions  in  any 
court  of  competent  jurisdiction  to  restrain  by  injunc- 
tion such  violations,  or  otherwise  to  enforce  such  orders 
and  regulations.  Whenever  such  local  board  of  health 
in  any  incorporated  village  shall  deem  the  sewers  of 
such  village  insufficient  to  properly  and  safely  sewer 
such  village,  and  protect  the  public  health,  it  shall 
certify  such  fact  in  writing  to  the  board  of  trustees 
of  such  village,  stating  and  recommending  what  addi- 
tions or  alterations  should  in  the  judgment  of  such- 
board  of  health  be  made,  with  its  reasons  therefor,  and 
thereupon  such  board  of  trustees  shall  immediately  con- 
vene and  consider  such  recommendations,  and  if  ap- 
proved by  such  board  of  trustees,  the  same  shall  be  cer- 
tified to  the  state  commissioner  of  health  for  his  ap- 
proval, and  if  such  recommendations  shall  be  approved 
by  the  state  commissioner  of  health,  it  shall  be  the  duty 
of  the  board  of  trustees  or  other  board  of  such  villaere 
having  jurisdiction  of  the  construction  of  sewers  therein. 


20  THE  PUBLIC   HEIAXTH   LAW 

if  there  be  sucli  a  board,  whether  sufficient  funds  shall 
be  on  hand  for  such  purpose  or  not,  to  forthwith  make 
such  additions  to  or  alterations  in  the  sewers  of  such 
village  and  execute  such  recommendations,  and  the  ex- 
penses thereof  shall  be  paid  for  wholly  by  said  village 
in  the  same  manner  as  other  village  expenses  are  paid 
or  by  an  assessment  of  the  whole  amount  against  the 
property  benefited,  or  partly  by  the  village  and  partly 
by  an  assessment  against  the  property  benefited,  as  the 
board  of  trustees  of  such  village  shall  by  resolution  de- 
termine. If  the  board  of  trustees  shall  determine  that 
such  expenses  shall  be  paid  partly  by  the  village  and 
partly  by  an  assessment  against  the  property  benefited, 
as  authorized  by  this  section,  it  shall  in  the  resolution 
making  such  determination  fix  the  proportion  of  such 
expense  to  be. borne  by  each,  and  the  proportion  thereof 
to  be  raised  by  an  assessment  against  the  property  bene- 
fited shall  be  assessed  and  collected  in  the  manner  pro- 
vided by  the  village  law  for  the  assessment  and  col- 
lection of  sewer  assessments.  Said  village  is  hereby  au- 
thorized to  raise  such  sum  as  may  be  necessary  for  the 
payment  of  the  expenses  incurred,  which  are  a  village 
charge,  if  any,  as  herein  provided,  in  addition  to  the 
amount  such  village  is  now  authorized  to  raise  by  law 
for  corporation  purposes,  and  such  board  shall  have  the 
right  to  acquire  such  lands,  rights  of  way,  or  other 
easements,  by  gift,  or  purchase,  or  in  case  the  same  can- 
not be  acquired  by  purchase  may  acquire  the  same  by 
condemnation  in  the  manner  provided  by  law. 

§  22.  Vital  statistics. —  Every  such  local  board  shall 
supervise  and  make  complete  the  registration  of  all 
births  and  deaths  occurring  within  the  municipality, 
and  the  cause  of  death  and  the  finding  of  coroners' 
juries,  in  accordance  with  the  methods  and  forms  pre- 
scribed by  the  state   department  of   health,   and,   after 


LOCAJL  BOABDS    OF   HEALTH  21 

registration,  promptly  forward  the  certificates  of  such 
births  and  deaths  to  the  state  bureau  of  vital  statistics 
on  or  before  the  fifth  of  each  month.  Every  physician 
or  midwife  attending  at  the  birth  of  a  child,  and  no 
physician  or  midwife  being  in  attendance,  the  parent 
or  custodian  of  a  child  born,  shall  cause  a  certificate  of 
such  birth  to  be  returned  within  thirty-six  hours  there- 
after to  the  local  board  of  health  or  person  designated 
by  it  to  receive  the  same,  which  shall  be  attested,  if  a 
birth,  by  the  physician  or  midwife,  if  any  in  attendance, 
and  no  physician  or  midwife  being  in  attendance,  by  the 
parent  or  custodian  of  a  child  born.  It  shall  be  the 
duty  of  the  physician  last  in  attendance  upon  any  per- 
son who  may  die  to  fill  out  a  certificate  of  the  death 
and  probable  cause,  and  duly  certify  to  same  and  deliver 
the  certificate  to  the  local  registrar  of  vital  statistics 
within  twenty-four  hours  after  the  death  occurs.  In 
case  an  inquest  is  required  by  law,  the  coroner  or  the 
coroner's  physician  shall  fill  out  the  said  certificate, 
and  if  no  inquest  is  required  and  no  physician  was  in 
attendance  at  the  time  of  death  or  immediately  prior 
thereto,  the  health  officer  of  the  municipality  or  his 
medical  assistant  shall  fill  out  and  file  the  said  certifi- 
cate. In  cities  of  the  first  class  it  shall  be  the  duty 
of  the  physician  in  attendance  immediately  prior  to  the 
death  of  any  person  to  view  the  body,  and  to  fill  out  a 
certificate  of  the  death  and  probable  cause,  and  duly 
certify  to  same  and  deliver  the  certificate  to  the  local 
registrar  of  vital  statistics  within  twenty-four  hours 
after  such  viewing  of  the  body.  The  person  making 
such  certificate  shall  be  entitled  to  the  sum  of  twenty- 
five  cents  therefor,  which  shall  be  a  charge  upon,  and 
paid  by  the  municipality  where  such  birth  or  death 
occurred.  The  cost  of  such  *regisration,  not  exceeding 
twenty-five   cents  for   the   complete   registered   record   of 

*So  in  original. 


22  THE  PUBLIC  HEAXTH  LAW 

a  birthj  or  death,  shall  be  a  charge  upon  the  munici- 
pality. The  charge  for  a  copy  thereof  shall  be  fixed 
by  the  board,  not  exceeding  the  same  sum  for  a  com- 
plete copy  of  a  single  registered  record  and  the  addi- 
tional sum  of  twenty-five  cents  if  certified  to.  Such 
copies  shall  be  furnished  upon  request  of  any  person, 
and  when  certified  to  be  correct  by  the  president  or 
secretary  of  the  board  or  local  registering  officer  desig- 
nated by  it  shall  be  presumptive  evidence  in  all  courts 
and  places  of  the  facts  therein  stated.  The  physician 
or  midwife  attending  at  the  birth  of  a  child,  shall,  at 
the  time  of  filing  such  certificate  of  birth,  unless  it  con- 
tains the  given  name  of  such  child,  cause  to  be  fur- 
nished to  the  parents  or  custodian  of  such  child,  a  name 
card,  which  shall  be  filled,  in  by  such  parent  or  cus- 
todian with  the  given  name  of  such  child  when  named, 
and  immediately  filed  in  the  same  office  where  certifi- 
cates of  birth  are  filed.  Blank  name  cards  shall  be  fur- 
nished by  local  boards  of  health  in  the  form  prescribed 
by  the  state  department  of  health,  the  expense  of  which 
shall  be  a  charge  upon  the  municipality.  Rules  and 
regulations  shall  be  adopted  by  local  boards  of  health 
providing  for  the  enforcement  of  this  section. 

§  23.  Burial  and  burial  permits. —  Every  such  local 
board  shall  prescribe  sanitary  regulations  for  the  burial 
and  removal  of  corpses,  and  shall  des'ignate  the  local 
registrar  of  vital  statistics  and  the  health  officer  of  the 
town  or  municipality  to  grant  permits  for  such  burial, 
and  permits  for  the  transportation  of  any  corpse  which 
is  to  be  carried  for  burial  beyond  the  county  where  the 
death  occurred.  Every  undertaker,  sexton  or  other  per- 
son having  charge  of  any  corpse,  shall  procure  a  burial 
permit  from  the  local  registrar  with  whom  the  certificate 
of  death  has  been  filed,  or  the  health  officer  of  the 
town  or  municipality  and  there  shall  be  no  burial  or 


LOCAL  BOABDS  OF  HEALTH  23 

removal  of  a  corpse  until  a  permit  for  such  burial  or 
removal  has  been  obtained.  When  application  is  made 
for  a  permit  to  transport  a  corpse  over  any  railroad  or 
upon  any  passenger  steamboat  within  the  state,  the 
board  of  health,  or  the  officers  to  whom  such  application 
is  made,  shall  require  such  a  corpse  to  be  inclosed  in  a 
hermetically  sealed  casket  of  metal  or  other  indestruct- 
ible material,  if  the  cause  of  death  shall  have  been  from 
a  contagious  or  infectious  disease. 

§  24.  Regulating  interments  in  cemeteries. —  "VMien- 
ever  the  common  council  of  any  city  of  the  third  class 
shall  deem  that  further  interments  in  any  cemetery  in 
such  city  would  be  detrimental  to  the  public  health,  it 
may  by  resolution  direct  its  clerk  to  cause  a  notice  to 
be  served  upon  the  person  or  corporation  owning  or  con- 
trolling such  cemetery  and  published  once  in  a  week 
for  three  successive  weeks  in  two  papers  published  in 
such  city,  stating  a  time  and  place  not  less  than  thirty 
days  after  service  and  first  publication  of  such  notice, 
at  which  any  person  interested  may  show  cause  to  the 
common  council  why  further  interments  in  such  ceme- 
tery should  not  be  prohibited.  At  the  time  and  place 
specified  in  such  notice  the  common  council  shall  hear 
all  persons  desiring  to  be  heard,  and  if  upon  such  hear- 
ing it  appears  that  further  interments  in  such  cemetery 
will  be  deterimental  to  public  health,  the  common 
council  may  by  resolution  prohibit  further  interments 
therein.  If  such  resolution  is  adopted  a  certified  copy 
thereof  shall  be  filed  by  the  clerk  of  the  common  council 
with  the  board  of  health  of  such  city,  and  thereafter 
such  board  shall  not  issue  any  permits  for  interments 
in  such  cemetery.  The  action  of  the  common  council 
in  passing  such  resolution  may  be  reviewed  within  thirty 
days  thereafter  by  writ  of  certiorari  as  provided  by  the 
code  of  civil  procedure. 


24  THE  PUBIIC  HEALTH  tAW 

§  25.  Infectious  and  contagious  or  communicable  dis- 
eases.—  Every  such  local  board  of  health  shall  guard 
against  the  introduction  of  such  infectious  and  con- 
tagious or  communicable  diseases  as  are  designated  by 
the  state  department  of  health,  by  the  exercise  of  proper 
and  vigilant  medical  inspection  and  control  of  all  per- 
sons and  things  infected  with  or  exposed  to  such  dis- 
eases, and  provide  suitable  places  for  the  treatment  and 
care  of  sick  persons  who  cannot  otherwise  be  provided 
for.  It  shall  prohibit  and  prevent  all  intercourse  and 
communication  with  or  use  of  infected  premises,  places 
and  things,  and  require,  and  if  necessary,  provide  the 
means  for  the  thorough  purification  and  cleansing  of 
the  same  before  general  intercourse  with  the  same  or 
use  thereof  shall  be  allowed.  Every  physician  shall 
immediately  give  notice  of  every  case  of  infectious  and 
contagious  or  communicable  disease  required  by  the 
state  department  of  health  to  be  reported  to  it,  to  the 
health  officer  of  the  city,  town  or  village  where  such 
disease  occurs,  and  no  physician  being  in  attendance  on 
such  case,  it  shall  be  the  duty  of  the  superintendent  or 
other  officer  of  an  institution,  householder,  hotel  or  lodg- 
ing house  keeper,  or  other  person  where  such  case  occurs, 
to  give  such  notice.  The  physician  or  other  person  giv- 
ing such  notice  shall  be  entitled  to  the  sum  of  twenty- 
five  cents  therefor  which  shall  be  a  charge  upon  and 
paid  by  the  municipality  where  such  case  occurs.  Every 
such  local  board  of  health  shall  report  to  the  state  de- 
partment of  health,  promptly,  the  facts  relating  to  in- 
fectious and  contagious  or  communicable  diseases,  and 
every  case  of  smallpox  or  varioloid  within  the  munici- 
pality. Healih  officers  of  cities,  villages  and  towns 
shall  report  in  writing  once  a  month  to  the  state  de- 
partment of  health  all  cases  of  such  infectious  and  con- 
tagious or  communicable  diseases  as  may  be  required 
by  the  state  department  of  health,  and  for  such  report- 


LOCAL  BOARDS  OF  HEALTH  25 

ing  the  health  officer  of  a  village  or  town  shall  be  paid 
by  the  municipality  employing  him,  upon  the  certifica- 
tion of  the  state  department  of  health,  a  sum  not  to  ex- 
ceed twenty  cents  for  each  case  so  reported.  The  re- 
ports of  cases  of  tuberculosis  made  pursuant  to  the  pro- 
visions of  this  section  shall  not  be  divulged  or  made 
public  so  as  to  disclose  the  identity  of  the  persons  to 
whom  they  relate,  by  any  person;  except  in  so  far  as 
may  be  necessary  to  carry  out  the  provisions  of  this 
section.  It  shall  provide  at  stated  intervals,  a  suitable 
supply  of  vaccine  virus,  of  a  quality  and  from  a  source 
approved  by  the  state  department  of  health,  and  during 
an  actual  epidemic  of  smallpox  obtain  fresh  supplies 
of  such  virus  at  intervals  not  exceeding  one  w^eek,  and 
at  all  times  provide  thorough  and  safe  vaccination  for  all 
persons  in  need  of  the  same.  If  a  pestilential,  infectious 
or  contagious  disease  exists  in  any  county  almshouse 
or  its  vicinity,  and  the  physician  thereof  shall  certify 
that  such  disease  is  likely  to  endanger  the  health  of  its 
inmates,  the  county  superintendent  of  the  poor  may 
cause  such  inmates  or  any  of  them  to  be  removed  to 
such  other  suitable  place  in  the  county  as  the  local 
board  of  health  of  the  municipality  where  the  almshouse 
is  situated  may  designate,  there  to  be  maintained  and 
provided  for  at  the  expense  of  the  county,  with  all 
necessary  medical  care  and  attendance  until  they  shall 
be  safely  returned  to  such  almshouse  or  otherwise  dis- 
charged. Tliis  section  shall  apply  to  all  cities,  towns 
and  villages,  except  cities  of  the  first  class,  notwith- 
standing the  provisions  of  section  thirty-two  of  this 
article.  The  health  officer,  commissioner  of  health,  or 
boards  of  health  of  the  cities  of  the  first  class  shall  re- 
port promptly  to  the  state  department  of  health  all 
cases  of  smallpox,  typhus  and  j^ellow  fever  and  cholera 
and  the  facts  relating  thereto. 


20  THE   PUBLIC    HEAXTH   LAW 

§  26.  Nuisances. —  Every  such  board  shall  receive  and 

examine  into  all  complaints  made  by  any  inhabitant 
concerning  nuisances,  or  causes  of  danger  or  injury  to 
life  and  health  within  the  municipality,  and  may  enter 
upon  or  within  any  place  or  premises  where  nuisances 
or  conditions  dangerous  to  life  and  health  or  which  are 
the  cause  of  nuisances  ea^isting  elsewhere  are  known  or 
believed  to  exist,  and  by  its  members  or  other  persons 
designated  for  that  purpose,  inspect  and  examine  the 
same.  The  owners,  agents  and  occupants  of  any  such 
premises  shall  permit  such  sanitary  examinations  to  be 
made,  and  the  board  shall  furnish  such  owners,  agents 
and  occupants  with  a  written  statement  of  the  results 
and  conclusions  of  any  such  examination.  Every  such 
local  board  shall  order  the  suppression  and  removal  of 
all  nuisances  and  conditions  detrimental  to  life  and 
health  found  to  exist  within  the  municipality.  When- 
ever the  state  department  of  health  shall  by  notice  to 
the  presiding  officer  of  any  local  board  of  health,  direct 
him  to  convene  such  local  board  to  take  certain  definite 
proceedings  concerning  which  the  state  department  of 
health  shall  be  satisfied  that  the  action  recommended 
by  them  is  necessary  for  the  public  good,  and  is  within 
the  jurisdiction  of  such  board  of  health,  such  presiding 
officer  shall  convene  such  local  board,  which  shall  take 
the  action  directed. 

§  27.  Owner  to  bear  all  or  part  of  expense  of  removal. 
—  "\^Tienever  the  local  board  of  health  of  a  municipality 
shall  determine  taat  any  accumulation  of  water  wherein 
mosquito  larvae  breed,  constitutes  a  nuisance  or  a 
danger  or  injury  to  life  or  health,  the  owner  or  owners 
of  the  premises  on  which  the  breeding  place  is  located 
shall  bear  the  expense  of  its  suppression  or  removal, 
or  o  much  thereof  as  the  local  board  may  have  de- 
termined to  be  equitable  as  hereinafter  provided,  and  for 
the  amount  thereof  an  action  may  be  maintained  in  the 


LOCAL  BOAEDS  OF  HEALTH  27 

name  of  the  nmnicipalitj  and  the  same  shall  become  a 
first  lien  on  the  premises  as  provided  by  section  thirty- 
one  and  thirty-two  of  this  article. 

§  28.  Assessing  cost  on  property  benefited. —  If  such 
local  board  shall  determine,  in  its  discretion,  that,  owing 
to  the  natural  conditions  which  are  favorable  to  the 
breeding  of  mosquitoes  and  owing  to  the  benefits  to  be 
secured  to  the  public  by  the  suppression  of  such  condi- 
tions, some  part  or  all  of  the  expense  of  suppressing  or 
removing  a  breeding  place  for  mosquitoes  should,  in 
equity,  be  borne  by  the  owners  of  the  property  which 
will  be  benefited  by  such  suppression  or  removal,  the 
local  board  shall  make  application  as  hereinafter  pro- 
vided, for  the  appointment  of  three  commissioners,  and 
the  county  court  of  the  county  in  which  are  situated  the 
premises  whereon  the  breeding  place  is  located,  or,  in 
case  such  premises  are  situated  in  more  than  one  county, 
the  supreme  court,  shall  thereupon  appoint  three  persons 
as  commissioners  to  proceed  with  the  work  necessary 
for  the  suppression  or  removal  of  such  breeding  place, 
and  to  apportion,  assess  and  collect  the  cost  thereof,  as 
so  determined  from  the  owners  of  such  property  bene- 
fited. Such  appointment,  apportionment,  assessment  and 
collection  shall  be  made  in  the  manner  provided  for  the 
appointment  of  commissioners  to  suppress  and  remove 
any  such  breeding  place  by  draining  the  premises  on 
which  such  breeding  place  is  located  by  means  of  ditches 
and  channels  constructed  over  lands  belonging  to  others 
and  the  owners  of  the  premises  to  be  drained  and  to  ap- 
portion, assess  and  collect  the  cost  thereof  from  the 
owners  of  the  property  benefited  thereby.  In  any  case 
where,  under  the  provisions  of  this  article  commissioners 
are  to  determine  what  property  is  benefited  and  to  what 
extent  said  property  is  benefited  by  the  suppression  or 
removal  of  any  such  breeding  place,  such  commissioners 


28  THE  PUBLIC   HEALTH   LAW 

shall  not  be  restricted  in  their  determination  to  prop- 
erty immediately  adjoining  the  premises  whereon  such 
breeding  place  is  located;  and,  in  apportioning  the  bene- 
fit to  any  property,  such  commissioners  may  consider  any 
circumstances  by  reason  whereof  any  property  will  be 
benefited  by  the  suppression  and  removal  of  such  breed- 
ing place. 

§  29.  Municipality  may  bear  part  of  expense. —  If  such 
local  board  shall  have  determined  that,  owing  to  the 
natural  conditions  which  are  favorable  to  the  breeding 
of  mosquitoes  and  owing  to  the  benefit  to  be  secured  to 
the  public  by  the  suppression  of  such  conditions,  a  part 
of  the  expense  of  such  suppression  or  removal  shall  be 
borne  by  the  owner  of  such  premises  and  a  part  thereof 
by  the  municipality  Avherein  the  premises  are  situated, 
such  owner  or  occupant  onay  proceed  to  suppress  or  re- 
move such  breeding  place  and  shall  be  reimbursed  by  the 
municipality  for  such  proportion  of  the  reasonable  ex- 
pense of  such  suppression  or  removal  as  the  local  board 
shall  have  determined  should  be  borne  by  the  municipal- 
ity. For  the  purpose  of  ascertaining  the  actual  cost  of 
such  suppression  or  removal,  the  local  board  or  its  duly 
authorized  agents  m.ay  at  all  times  have  access  to  the 
premises  whereon  the  work  is  being  carried  on;  and  the 
owner  of  the  premises  shall  furnish  to  such  local  board 
such  information  as  such  local  board  may  deem  neces- 
sary or  desirable  for  the  purpose  of  ascertaining  such 
actual  cost.  If  in  any  such  case  the  owner  of  the  prem- 
ises shall  not,  within  a  reasonable  time,  proceed  to  sup- 
press or  remove  such  breeding  place,  the  local  board 
may  proceed  to  suppress  and  remove  the  same,  and  for 
such  proportion  of  the  expense  of  such  suppression  and 
removal  as  the  local  board  shall  have  determined  to  be 
equitable,    an    action  may  be   maintained   against  such 


LOCAL  BOAEDS  OF  HEALTH  29 

owner,  and  the  same  shall  become  a  first  lien  upon  the 
premises  as  above  provided. 

§   30.    Assessing   expense    upon   property  benefited. — 

If  such  local  board  shall  deem  it  necessarr.  in  order  to 
suppress  or  remove  any  such  breeding  place,,  that  any 
swamp,  bog,  meadow  or  other  low  or  wet  lands  within 
the  municipality  over  which  said  board  has  jurisdiction, 
shall  be  drained  and  that  it  is  necessary,  in  order 
thereto,  that  a  ditch  or  ditches  or  other  channel  for  the 
free  passage  of  water  should  be  opened  through  lands 
belonging  to  a  person  or  persons  other  than  the  owners 
of  said  swamp,  bog,  meadow  or  other  low  or  wet  lands, 
or  that  any  other  act  or  thing  be  done  upon  or  over  land 
belonging  to  others  than  the  owners  of  the  lands 
whereon  such  breeding  place  shall  be  located,  such  board 
shall  make  application  for  the  appointment  of  three 
commissioners  to  construct  and  complete  such  chan- 
nels and  ditches  for  the  free  passage  of  water,  or  to 
do  such  other  act  or  thing  as  such  local  board  shall 
have  determined  to  be  necessary  upon  such  lands  in 
order  to  suppress  or  remove  such  breeding  place, 
and  to  apportion,  assess  and  collect  the  amount  of 
the  cost  thereof  from  the  owners  of  the  lands  which 
will  be  benefited  by  the  suppression  and  removal  of 
such  breeding  place.  Such  commissioners  shall  be  ap- 
pointed, and  shall  proceed,  when  appointed,  to  construct 
and  complete  such  channels  and  ditches,  or  do  such 
other  act  or  thing  as  may  be  necessary,  and  to  appor- 
tion, assess  and  collect  the  cost  of  the  same  from  the 
owners  of  the  lands  benefited  by  such  suppression  or 
removal,  in  the  manner  provided  for  the  appointment 
of  commissioners  for  the  drainage  of  any  swamp,  bog, 
meadow  or  other  low  or  wet  land  and  the  apportion- 
ment, assessment  and  collection  of  the  cost  of  such 
drainage,  by  the  drainage  law,  and  this  article  shall  be 


30  THE  PUBLIC  HEALTH  LAW 

construed  with,  the  provisions  of  such  drainage  law.  In 
case  of  conflict  the  provisions  of  this  article  shall  be 
substituted  for  the  provisions  of  such  drainage  law,  but 
such  parts  of  the  provisions  of  the  drainage  law  as  are 
not  necessarily  superseded  shall  apply. 

§  31.  Removal  of  nuisances. —  If  the  owner  or  occu- 
pant of  any  premises  whereon  any  nuisance  or  condi- 
tion deemed  to  be  detrimental  to  the  public  health  exists 
or  the  cause  of  the  existence  elsewhere,  fails  to  comply 
with  any  order  or  regulation  of  any  such  local  board 
for  the  suppression  and  removal  or  any  such  nuisance 
or  other  matter,  in  the  judgment  of  the  board  detri- 
mental to  the  public  health,  made,  served  or  posted  as 
required  in  this  article,  such  boards  or  their  servants 
or  employees  may  enter  upon  the  premises  to  which  such 
order  or  regulation  relates,  and  suppress  or  remove  such 
nuisance  or  other  matter.  The  expense  of  such  suppres- 
sion or  removal  shall  be  paid  by  the  owner  or  occupant 
of  such  premises,  or  by  the  person  who  caused  or  main- 
tained such  nuisance  or  other  matters,  and  the  board 
may  maintain  an  action  in  the  name  of  the  municipality 
to  recover  such  expense,  and  the  same  when  recovered 
shall  be  paid  to  the  treasurer  of  the  municipality,  or  if 
it  has  no  treasurer  to  its  chief  fiscal  officer,  to  be  held 
and  used  as  the  funds  of  the  municipality.  Whenever 
the  suppression  or  removal  of  such  nuisance  or  condi- 
tions detrimental  to  health  demand  the  immediate  ex- 
penditure of  money,  every  such  local  board  of  health 
shall  be  authorized  to  use  for  such  purpose  any  money 
in  the  hands  of  the  board,  or  may  call  on  the  city 
council,  village  trustees  or  town  board  for  such  money 
or  it  may  borrow  the  same  on  the  credit  of  the  munici- 
pality. All  such  moneys  so  expended  or  borrowed  shall 
be  inuneaiately  repaid  to  the  fund  or  source  whence  they 
were  received  on  the  recovery  of  the  same  by  action  or 


LOCAL  BOAEDS  OF   HEALTH  31 

otherwise  from  the  persons  responsible  for  the  expenses 
of  suppression  or  removal. 

§  32.  Expense  of  abatement  of  nuisances  a  lien  upon 
the  premises. —  If  execution  upon  a  judgment  for  the 
recovery  of  the  expense  of  the  suppression  or  re- 
moval of  a  nuisanee  or  other  matter,  pursuant  to  an 
order  or  regulation  of  any  such  local  board,  is  re- 
turned wholly  or  in  part  unsatisfied,  such  judgment, 
if  docketed  in  the  place  and  manner  required  by 
law  to  make  a  judgment  of  a  court  of  record  a  lien 
upon  real  property,  shall  be  a  first  lien  upon  such 
premises,  having  preference  over  all  other  liens  and  in- 
cumbrances whatever.  The  board  may  cause  such  prem- 
ises to  be  sold  for  a  term  of  time  for  the  payment  and 
satisfaction  of  such  lien  and  the  expenses  of  the  sale. 
Xotice  of  such  sale  shall  be  published  for  twelve  weeks 
successively,  at  least  once  in  each  week,  in  a  newspaper 
of  the  city,  village  or  town,  or  if  no  newspaper  is  pub- 
lished therein,  in  the  newspaper  published  nearest  to 
such  premises.  If  the  owner  or  occupant  of  the  prem- 
ises, or  his  agent,  is  known,  a  copy  of  such  notice  shall 
be  served  upon  him,  either  personally,  at  least  fourteen 
days  previous  to  the  sale,  or  by  mail  at  least  twenty- 
eight  days  prior  thereto.  The  premises  shall  be  sold  to 
the  person  ofi'ering  to  take  them  for  the  shortest  time, 
paying  the  amount  unpaid  on  such  judgment  and  inter- 
est and  the  expenses  of  such  notice  and  sale.  A  certifi- 
cate of  the  sale,  signed  and  acknowledged  by  the  presi- 
dent and  secretary  of  the  board,  shall  be  made  and  de- 
livered to  the  purchaser,  and  may  be  recorded  as  a  con- 
veyance of  real  property,  and  the  purchaser  shall  there- 
upon be  entitled  to  the  immediate  possession  of  such 
premises,  and,  if  occupied,  may  maintain  an  action  or 
proceeding  to  recover  the  possession  thereof  against  the 
occupant,  as  against  a  tenant  of  real  property  holding 


32  THE  PUBLIC  HEAXTH  LAW 

over  after  the  expiration  of  his  term;  and  the  cost  of 
any  such  action  or  proceeding,  if  not  paid  by  the  occu- 
pant, shall  also  be  a  lien  upon  such  premises,  having  the 
same  preference  as  the  lien  of  such  judgment,  and  the 
right  of  the  purchaser  to  such  premises  shall  be  extended 
for  a  longer  term,  which  shall  bear  the  same  proportion 
to  the  original  term  as  the  amount  of  such  costs  bears 
to  the  amount  paid  by  the  purchaser  on  such  sale.  The 
term  of  the  purchaser  at  any  such  sale  shall  commence 
when  he  shall  have  acquired  possession  of  the  premises 
sold.  At  any  time  within  six  months  after  recording 
such  certificate,  the  owner  of  the  premises  or  any  lessee, 
mortgagee  or  incumbrancer  thereof,  or  of  any  part  of 
the  same,  may  redeem  the  premises  or  any  such  part 
from  such  sale  by  paying  to  the  purchaser  the  amount 
paid  by  him  on  the  sale,  and  all  costs  and  expenses  in- 
curred by  him  in  any  action  or  proceeding  to  recover 
possession  with  interest  at  the  rate  of  ten  per  centum 
per  annum  thereon.  If  redemption  is  made  by  the 
owner,  the  right  of  the  purchaser  shall  be  extinguished; 
if  by  a  lessee,  the  amount  paid  shall  be  applied  as  a  pay- 
ment upon  any  rent  due  or  which  may  accrue  upon  his 
lease ;  if  by  a  mortgagee  or  an  incumbrancer,  the  amomit 
paid  shall  be  added  to  his  mortgage,  incumbrance  or 
other  lien,  or  if  he  have  more  than  one  to  the  oldest, 
and  shall  thereafter  be  a  part  of  such  mortgage,  lien  or 
incumbrance  and  enforceable  as  such. 

§  33.  Manufacturers  in  tenement  houses  and  dwellings. 

—  No  room  or  apartment  in  a  tenement  or  dwelling 
house,  used  for  eating  or  sleeping  purposes,  shall  be 
used  for  the  manufacture,  wholly  or  partly,  of  coats, 
vests,  trousers,  knee  pants,  overalls,  cloaks,  shirts, 
purses,  feathers,  artificial  flowers  or  cigars,  except  by 
the  members  of  the  family  living  therein,  which  shall 
include  a  husband  and  wife  and  their  children,  or  the 


LOCAL  BOARDS  OF  HEALTH  33 

hildren  of  either.  A  family  occupying  or  controllino- 
uch  a  workshop  shall,  within  fourteen  days  from  the 
ime  of  beginning  work  therein,  notify  the  board  of 
ealth  of  the  city,  village  or  town,  where  such  work- 
hop  is  located,  or  a  special  inspector  appointed  by  such 
card,  of  the  location  of  such  workshop,  the  nature 
f  the  work  carried  on,  and  the  number  of  persons  em- 
loyed  therein;  and  thereupon  such  board  shall,  if  it 
eems  advisable,  cause  a  permit  to  be  issued  to  such 
imily  to  carry  on  the  manufacture  specified  in  the 
otice.  Such  board  may  appoint  as  many  persons  as 
;  deems  advisable  to  act  as  special  inspectors.  Such 
pecial  inspectors  shall  receive  no  compensation,  but 
Lay  be  paid  by  the  board  their  reasonable  and  neces- 
iry  expenses.  If  a  board  of  health  or  such  inspector 
lali  find  evidence  of  infectious  or  contagious  diseases 
resent  in  any  workshop,  or  in  goods  manufactured  or 
I  process  of  manufacture  therein,  the  board  shall  issue 
ich  orders  as  the  public  health  may  require,  and  shall 
mdemn  and  destroy  such  infectious  and  contagious 
•tides,  and  may,  if  necessary  to  protect  the  public 
jalth,  revoke  any  permit  granted  by  it  for  manufac- 
iring  goods  in  such  workshop.  If  a  board  of  health  or 
ly  such  inspector  shall  discover  that  any  such  goods 
•e  being  brought  into  the  state,  ha^cing  been  manu- 
ictured,  in  whole  or  in  part,  under  unhealthy  condi- 
ons,  such  board  or  inspector  shall  examine  such  goods, 
id  if  they  are  found  to  contain  veiinin,  or  to  have 
|en  made  in  improper  places  or  under  unhealthy  con- 
tions,  the  board  may  make  such  orders  as  the  public 
alth  may  require,  and  may  condemn  and  destroy  such 
ods. 

§   34.   Jurisdiction    of   town    and   village   boards. —  A 

IwTi  board  of  health  shall   not  have  jurisdiction  over 
3 


34  THE  PUBLIC    HEAXTH    LAW 

any  city  or  incorporated  village  or  part  of  such  city  or 
village  in  such  town  if  such  city  or  village  has  an  or- 
ganized board  of  healt^.  The  boards  of  health  of  any 
town  and  the  incorporated  villages  therein,  or  any  two 
or  more  towns  and  the  incorporated  villages  therein, 
may  unite,  with  the  written  approval  of  the  state  de- 
partment of  health,  in  a  combined  sanitary  and  regis- 
tration district,  and  appoint  for  such  district  one  health 
officer  and  registering  officer,  whose  authority  in  all 
matters  of  general  application  shall  be  derived  from 
the  boards  of  health  appointing  him,  and  in  special 
cases  not  of  general  application  arising  within  the  juris- 
diction of  but  one  board,  shall  be  derived  from  such 
board  alone.  When  one  or  more  towns  and  the  incor- 
porated -vnllages  therein  unite  in  one  registration  dis- 
trict, the  registrar  of  vital  statistics  of  such  combined 
district  will  be  required  to  make  separate  returns  to 
the  state  department  of  health  of  village  and  town  cer- 
tificates of  births,  marriages  and  deaths. 

§  35.  Expenses,  how  paid. — All  expenses  incurred  by 

any  local  board  of  health  in  the  performance  of  the 
duties  imposed  upon  it  or  its  members  by  law  shall  be 
a  charge  upon  the  municipalit}*,  and  shall  be  audited, 
levied,  collected  and  paid  in  the  same  manner  as  the 
other  charges  of,  or  upon,  the  municipality  are  audited, 
levied,  collected  and  paid.  The  taxable  property  of  any 
village  maintaining  its  own  board  of  health  shall  not 
be  subject  to  taxation  for  maintaining  any  town  board 
of  health,  or  for  any  expenditure  authorized  by  the 
town  board  of  health,  but  the  costs  and  expenditures 
of  the  town  board  shall  be  assessed  and  collected  ex- 
clusively on  the  property  of  the  town  outside  of  any 
such  village. 


LOCAi  BOARDS  OE  HEALTH  35 

§  36.  Relief  of  indigent  Indians  in  case  of  epidemic— 
Whenever  an  epidemic  of  a  contagious  or  infectious 
disease  shall  prevail  among  the  Indians  of  any  nation, 
tribe  or  band  in  this  state,  the  overseer  of  the  poor  of 
any  town  in  which  the  reservation  of  such  nation,  tribe 
or  band  is  wholly  or  partly  situated,  may  in  accordance 
with  rules  and  regulations  adopted  by  the  state  com- 
missioner of  health,  cause  needed  medical  attendance, 
provisions  and  maintenance  to  be  furnished  to  any  in- 
digent Indian  residing  in  the  town,  who,  or  a  member 
of  whose  family,  is  afflicted  with  such  disease,  while 
such  disease  shall  continue;  and  the  cost  thereof  after 
being  audited  as  herein  provided  shall  be  a  state  charge. 
A  verified  statement  of  any  expenses  incurred  under 
this  section  shall  be  transmitted  by  the  overseer  of  the 
poor  to  the  state  commissioner  of  health.  Such  com- 
missioner shall  examine  into  the  matter,  and  if  satisfied 
that  such  expenses  were  properly  and  necessarily  in- 
curred in  accordance  with  the  rules  and  regulations  of 
the  state  commissioner  of  health,  shall  audit  and  allow 
the  same,  and  when  so  audited,  the  amount  thereof  shall 
be  paid  by  the  state  treasurer  on  the  warrant  of  the 
comptroller  to  such  overseer  of  the  poor. 

§  37.  Mandamus. —  The  performance  of  any  duty  or 
the  doing  of  any  act  enjoined,  prescribed  or  required  by 
this  article,  may  be  enforced  by  mandamus  at  the  in- 
stance of  the  state  department  of  health  or  its  president 
or  secretary,  or  of  the  local  board  of  health,  or  of  any 
citizen  of  full  age  resident  of  the  municipality  where 
the  duty  should  be  performed  or  the  act  done. 

§  38.  Exceptions  and  limitations  as  to  cities  of  New 
JTork,  Brooklyn,  Buffalo,  Albany  and  Yonkers. —  Sections 
twenty  to  thirty-eight  inclusive  of  this  article  shall 
aot  be  construed  to  affect,  alter  or  repeal  laws  now  in 


36  THE   PUBLIC    HEALTH    LAW 

force  relating  to  the  boards  of  health  of  the  cities  of 
New  York,  Brooklyn,  Buffalo,  Albany  and  Yonkers,  nor 
the   sanitary  codes   duly   adopted   and   now    in   force    in 

such  cities, 

§  39.  Certain  kinds  of  business  and  manufacture  pro- 
hibited in  cities  or  within  three  miles  therefrom;  ex- 
ceptions.—  It  shall  not  be  lawful  for  any  person  or 
persons  to  engage  in  or  carry  on  the  business  of  fat 
rendering,  bone  boiling  or  the  manufacture  of  fertilizers 
or  any  business  as  a  public  nuisance  within  the  cor- 
porate limits  of  any  incorporated  city  of  this  state,  or 
within  a  distance  of  three  miles  from  the  corporate 
limits  of  any  incorporated  city,  provided,  however,  that 
nothing  herein  contained  shall  prevent  the  rendering  of 
fresh  killed  cattle  or  swine.  All  departments  of  health 
or  the  commissioner  or  commissioners  thereof  in  any 
incorporated  city  of  this  state  shall  have  power  to 
enforce  the  provisions  of  this  section.  Any  person  or 
persons  offending  against  the  provisions  of  this  section 
shall,  upon  conviction  thereof,  be  guilty  of  a  misde- 
meanor. This  section  shall  not  apply  to  the  counties 
of  Fulton,  Wayne,  Tompkins,  Chautauqua,  Orange, 
Dutchess,  Erie,  Monroe,  Oneida,  Onondaga,  New  York, 
Schoharie,  Ulster,  Greene,  Cayuga,  Cattaraugus,  Niag- 
ara, Saratoga,  Schenectady,  Hamilton,  Montgomery  and 
Orleans. 


POTABLE    WATEBS  37 

ARTICLE  V 
Potable  Waters 
!-^ction  70,  Eules  and  regulations  of  department. 

71.  Inspection  of  water  supply. 

72.  Rules    and    regulations    for    water    supplies 

legalized, 

73.  Sewerage. 

74.  Discharge  of  sewage  into  *Walkill  creek  pro- 

hibited. 

75.  Discharge    of   sewage   into   the    Susquehanna 

near  Binghamton  prohibited. 

76.  Discharge  of  sewage  and  other  refuse  matter 

into  certain  waters  prohibited. 

77.  Permission  to  discharge  sewage. 

78.  Permission  to  discharge  refuse  or  waste  mat- 

ter from  industrial  establishments. 

79.  Plans    for    refuse    discharge    pipes    must   be 

submitted. 

80.  Revocation  of  permit. 

81.  Reports    of    municipal    authorities    to    local 

boards  of  health. 

82.  Reports    of    proprietors    of    industrial   estab- 

lishments. 

83.  Record  of  permits;  inspection  of  local  boards 

of  health. 

84.  Violations;     service    of    notice;     actions    by 

local  boards. 

85.  Penalties. 

86.  Constructions   and  limitations  made   by    sec- 

tions seventy-six  to  eighty-five,  inclusive. 

87.  Actions    by    municipalities    to    prevent    dis- 

charge of  sewage  into  waters. 

§    70.    Rules    and    regulations    of    department. —  The 
state  department  of  health  may  make  rules  and  regula- 
*  So  in  original. 


38  THE  PUBLIC  HEALTH  LAW 

tions  for  the  protection  from  contamination  of  any  or 
all  public  supplies  of  potable  waters  and  their  sources 
within  tne  state.  If  any  such  rule  or  regulation  relates 
to  a  temporary  source  or  act  of  contamination,  any 
person  violating  such  rule  or  regulation  shall  be  liable 
to  prosecution  for  misdemeanor  for  every  such  violation, 
and  on  conviction  shall  be  punished  by  ^a  fine  not  ex- 
ceeding two  hundred  dollars,  or  imprisonment  not  ex- 
ceeding one  year,  or  both.  If  any  such  rule  or  regula- 
tion relates  to  a  permanent  source  or  act  of  contamina- 
tion, said  department  may  impose  penalties  for  the  vio- 
lation thereof  or  the  non-compliance  therewith,  not  ex- 
ceeding two  hundred  dollars  for  every  such  violation  or 
non-compliance.  Every  such  rule  or  regulation  shall 
be  published  at  least  once  in  each  week  for  six  consecu- 
tive weeks,  in  at  least  one  newspaper  of  the  county 
where  the  waters  to  which  it  relates  are  located.  The 
cost  of  such  publication  shall  be  paid  by  the  corpora- 
tion or  municipality  benefited  by  the  protection  of  the 
water  supply,  to  which  the  rule  or  regulation  published 
relates.  The  affidavit  of  the  printer,  publisher  or  pro- 
prietor of  the  newspaper  in  which  such  rule  or  regula- 
tion is  published  may  be  filed,  with  the  rule  or  regula- 
tion published,  in  the  county  clerk's  office  of  such 
county,  and  such  affidavit  and  rule  and  regulation  shall 
be  conclusive  evidence  of  such  publication,  and  of  all  the 
facts  therein  stated  in  all  courts  and  places. 

§  71.  Inspection  of  water  supply. —  The  officer  or  board 
having  by  law  the  management  and  control  of  the 
potable  water  supply  of  any  municipality,  or  the  cor- 
poration furnishing  such  supply,  may  make  such  inspec- 
tion of  the  sources  of  such  water  supply,  as  such  officer, 
board  or  corporation  aeems  advisable,  and  to  ascertain 
whether  the  rules  or  regulations  of  the  state  department 
are    complied    with,    and    shall    make    such    regular    or 


POTABLE  WATERS  39 

special  inspections  as  the  state  commissioner  of  health 
may  prescribe.  If  any  such  inspection  discloses  a  vio- 
lation of  any  such  rule  or  regulation  relating  to  a  per- 
manent source  or  act  of  contamination,  such  officer, 
board  or  corporation  shall  cause  a  copy  of  the  rule  or 
regulation  violated  to  be  served  upon  the  person  vio- 
lating the  same,  with  a  notice  of  such  violation.  If  the 
person  served  does  not  immediately  comply  with  the  rule 
or  regulation  violated,  such  officer,  board  or  corporation 
shall  notify  the  state  department  of  the  violation,  which 
shall  immediately  examine  into  such  violation;  and  if 
such  person  is  found  by  the  state  department  to  have 
actually  violated  such  rule  or  regulation,  the  commis- 
sioner of  health  shall  order  the  local  board  of  health 
of  such  municipality  wherein  the  violation  or  the  non- 
compliance occurs  to  convene  and  enforce  obedience  to 
such  rule  or  regulation.  If  the  local  board  fails  to 
enforce  such  order  within  ten  days  after  its  receipt,  the 
corporation  furnishing  such  water  supply,  or  the  munici- 
pality deriving  its  water  supply  from  the  waters  to 
which  such  rule  or  regulation  relates,  or  the  state  com- 
missioner of  health  or  the  local  board  of  health  of  the 
municipality  wherein  the  water  supply  protected  by 
these  rules  is  used,  or  any  person  interested  in  the  pro- 
tection of  the  purity  of  the  water  supply,  may  maintain 
an  action  in  a  court  of  record,  which  shall  be  tried  in 
the  county  where  the  cause  of  action  arose  against  such 
person,  for  the  recovery  of  the  penalties  incurred  by 
such  violation,  and  for  an  injunction  restraining  him 
from  the  continued  violation  of  such  rule  or  regulation. 

§  72.  Rules  and  regulations  for  water  supplies  legal- 
ized.— All  rules  and  regulations  heretofore  duly  made 
and  published  for  the  sanitary  protection  of  public 
water  supplies,  pursuant  to  chapter  five  hundred  and 
forty-three  of  the  laws  of  eighteen  hundred  and  eighty- 


40  THE   PUBLIC    HEALTH    LAW 

five,  and  chapter  six  hundred  and  sixty-one  of  the  law 
of  eighteen  hundred  and  ninety-three,  as  amended,  ar 
hereby  legalized,  ratified,  confirmed  and  continued  ii 
force,  until  new  rules  and  regulations  become  operative 
This  section  and  the  two  preceding  sections  shall  no 
be  construed  to  repeal  or  affect  any  of  the  provisions  o 
chapter  three  hundred  and  seventy -eight  of  the  laws  o: 
eighteen  hundred  and  ninety-seven,  or  its  amendments. 

§  73.  Sewerage. — When  the  state  department  of  health 
shall,  for  the  protection  of  a  water  supply  from  con 
tamination,  make  orders  or  regulations  the  execution  ol 
which  will  require  or  make  necessary  the  constructior 
and  maintenance  of  any  system  of  sewerage,  or  a  change 
thereof,  in  or  for  any  village  or  hamlet,  whether  in^ 
corporated  or  unincorporated,  or  the  execution  of  which 
will  require  the  providing  of  some  public  means  of  re- 
moval or  purification  of  sewage,  the  municipality  or 
corporation  owning  the  water  works  benefited  thereby 
shall,  at  its  own  expense,  construct  and  maintain  such 
system  of  sewerage,  or  change  thereof,  and  provide  and 
maintain  such  means  of  removal  and  purification  of 
sewage  and  such  works  or  means  of  sewage  disposal  as 
shall  be  approved  by  the  state  department  of  health. 
When  the  execution  of  any  such  regulations  of  the  state 
department  of  health  will  occasion  or  require  the  remo- 
val of  any  building  or  buildings,  the  municipality  or 
corporation  owning  the  water  works  benefited  thereby 
shall,  at  its  own  expense,  remove  such  buildings  and 
pay  to  the  owner  thereof  all  damages  occasioned  by  such 
removal.  When  the  execution  of  any  such  regulation 
will  injuriously  aflfect  any  property  the  municipality  or 
corporation  owning  the  water  works  benefited  thereby 
shall  make  just  and  adequate  compensation  for  the 
property  so  taken  or  injured.  Until  such  construction 
or  change   of  such   system   or   systems   of  sewerage,   a,nd 


POTABLE   WATERS  41 

the  providing  of  such  means  of  removal  or  purification 
3f  sewage,  and  such  works  or  means  of  sewage  disposal 
md  the  removal  of  any  building,  are  so  made  by  the 
municipality  or  corporation  owning  the  water  works  to 
c>e  benefited  thereby  at  its  own  expense,  and  until  the 
municipality  or  corporation  owning  the  water  works 
benefited  shall  make  just  and  adequate  payment  for  all 
injuries  to  property  and  for  all  injuries  caused  to  the 
legitimate  use  or  operation  of  such  property,  there  shall 
be  no  action  or  proceeding  taken  by  any  such  municipal- 
ity, officer,  board,  person  or  corporation  against  any 
person  or  corporation  for  the  violation  of  any  regula- 
tion of  the  state  department  of  health  under  this  article, 
and  no  person  or  corporation  shall  be  considered  to  have 
violated  or  refused  to  obey  any  such  rule  or  regulation. 
The  owner  of  a.nj  building  the  removal  of  which  is  occa- 
sioned or  required,  or  which  has  been  removed  by  any 
rule  or  regulation  of  the  state  department  of  health 
made  under  the  provisions  of  this  article,  and  all  per- 
sons whose  rights  of  propertj^  are  injuriously  affected 
by  the  enforcement  of  any  such  rule  or  regulation,  shall 
have  a  cause  of  action  against  the  municipality  or  cor- 
poration owning  the  water  works  benefited  by  the  en- 
forcement of  such  rule  or  regulation,  for  all  damages 
occasioned  or  sustained  by  such  removal  or  enforcement, 
and  an  action  therefor  may  be  brought  against  such 
municipality  or  corporation  in  any  court  of  record  in 
the  county  in  which  the  premises  or  property  affected 
is  situated  and  shall  be  tried  therein;  or  such  dam- 
ages may  be  determined  by  a  special  proceeding  in 
the  supreme  court  or  the  county  court  of  the  county 
in  which  the  property  is  situated.  Such  special 
proceedings  shall  be  commenced  by  petition  and  no- 
tice to  be  served  by  such  ow^ner  upon  the  municipality 
or  corporation  in  the  same  manner  as  for  the  commence- 
ment of  condemnation  proceedings.      Such   municipality 


42  THE  PUBLIC  HEALTH   LAW 

or  corporation  may  make  and  serve  an  answer  to  sucli 
petition  as  in  condemnation  proceedings.  The  petition 
and  answer  shall  set  forth  the  claims  of  the  respective 
parties,  and  the  provisions  of  the  condemnation  law 
shall  be  applicable  to  the  subsequent  proceedings  upon 
the  petition  and  answer,  if  any.  Either  party  may, 
before  the  service  of  the  petition  or  answer  respectively, 
offer  to  take  or  pay  a  certain  sum,  and  no  costs  shall 
be  awarded  against  either  party  unless  the  judgment  is 
more  unfavorable  to  him  than  his  offer. 

§  74.  Discharge  of  sewage  into  Wallkill  creek  pro- 
hibited.— ^No  person  or  corporation  shall  permit  the  dis- 
charge or  escape  of  any  sewage,  or  other  matter  deleteri- 
ous to  public  health,  or  destructive  to  fish,  or  throw  or 
cast  any  dead  animal,  carrion  or  offal,  or  other  putrid 
or  oft'ensive  matter  into  the  waters  of  the  Wallkill  creek, 
in  the  counties  of  Ulster  and  Orange.  Any  person  violat- 
ing any  provision  of  this  section  shall  forfeit  to  the 
county  where  the  violation  occurred  the  sum  of  fifty 
dollars  for  every  such  violation. 

§  75.  Discharge  of  sewage  into  the  Susquehanna  near 
Binghamton  prohibited. —  No  person  or  corporation  shall 
cause  to  fall,  flow  or  discharge  into  the  Susquehanna 
river  or  any  of  its  tributaries,  between  the  Rock  Bottom 
dam  in  such  river  at  the  city  of  Binghamton,  and  a 
point  one  mile  east  of  the  bridge  that  crosses  such  river 
at  Conklin,  any  sewage  matter,  or  other  foul,  noxious  or 
deleterious,  solid  or  liquid  matter,  or  any  matter  that 
may  be  declared  such  by  the  board  of  health  of  any 
municipality  adjacent  to  such  river  within  such  limit. 
The  board  of  health  of  any  such  municipality  shall  ex- 
amine into  any  alleged  offense  against  this  section  and 
cause  the  same  to  be  abated,  if  found  to  exist.  Every 
person  violating  any  provision  of  this  section  shall  for- 


POTABLE   WATEES  43 

feit  to  the  municipality  having  a  local  board  of  health 
where  the  violation  occurs  the  sum  of  twenty-five  dollars 
for  the  first  day  when  tne  violation  takes  place,  and  the 
sum  of  ten  dollars  for  every  subsequent  day  that  such 
violation  is  repeated  or  continued. 

§  76.  Discharge  of  sewage  and  other  refuse  matter 
into  certain  waters  prohibited. —  Xo  person,  corporation 
or  municipality,  shall  place  or  cause  to  be  placed,  or 
discharge  or  cause  to  be  discharged  into  any  of  the 
waters  of  this  state,  unless  the  same  shall  have  been 
permitted  by  the  state  commissioner  of  health,  any 
sewage,  garbage,  offal,  dead  animal,  dead  fish,  dead  bird 
or  part  thereof,  or  any  decomposable  or  putrescible 
matter  of  any  kind  or  any  substance,  chemical  or  other- 
wise, containing  the  same  in  quantities  injurious  to  the 
public  health,  or  any  refuse  or  waste  matter,  either 
solid  or  liquid,  in  quantities  injurious  to  the  public 
health,  from  any  shop,  factory,  mill  or  industrial  estab- 
lishment; unless  express  permission  to  do  so  shall  have 
been  first  given  in  writing  by  the  state  commissioner  of 
health  as  provided  in  this  article,  except  as  hereinafter 
provided.  But  this  section  shall  not  prevent  the  dis- 
charge of  sewage  from  any  public  sewer  system  owned 
and  maintained  by  a  municipality,  or  the  discharge  of 
refuse  or  waste  matter  from  any  shop,  factory,  mill  or 
industrial  establishment,  provided  such  sewer  system 
was  in  operation  and  was  discharging  sewage,  or  such 
shop,  factory,  mill  or  industrial  establishment  was  in 
operation  and  discharging  refuse  or  waste  matter,  into 
any  of  the  waters  of  this  state  on  or  prior  to  May 
seventh,  nineteen  hundred  and  three,  nor  to  any  exten- 
sion or  modification  of  such  shop,  factory,  mill  or  in- 
dustrial establishment  or  reconstruction  thereof,  pro- 
vided the  refuse  or  waste  matter  discharged  therefrom 
is  not  materially  changed  or  increased;  but  this  excep- 


44  THE  PUBIIC   HEAJLTH  LAW 

tion  shall  not  permit  any  increase  in  the  discharge  of 
such  sewage,  nor  shall  it  permit  the  discharge  of  sewage 
from  a  sewer  system  which  shall  be  extended,  modified 
or  reconstructed  subsequent  to  said  date. 

§  77.  Permission  to  discharge  sewage. —  Upon  applica- 
tion duly  made  to  the  state  commissioner  of  health  by 
the  public  authorities  having  by  law  the  charge  of  the 
sewer  system  of  any  municipality,  the  state  commis- 
sioner of  health  shall  have  power  to  consider  the  case 
of  a  sewer  system  otherwise  prohibited  by  the  preceding 
section  from  discharging  sewage  into  any  of  the  waters 
of  the  state,  and  Avhenever  in  his  opinion  the  general 
interests  of  the  public  health  would  be  subserved 
thereby,  he  may  issue  a  permit  for  the  discharge  of 
sewage  from  any  such  sewer  system  into  any  of  the 
waters  of  the  state,  and  may  stipulate  in  the  permit, 
modifications,  regulations  and  conditions  on  which  such 
discharge  may  be  permitted.  Such  permit  before  being 
operative  shall  be  recorded  in  the  county  clerk's  office 
of  the  county  wherein  the  outlet  of  the  said  sewer  sys- 
tem is  located,  and  a  copy  of  the  permit  shall  be  trans- 
mitted by  the  state  commissioner  of  health  to  the  board 
of  health  of  the  municipality  wherein  the  outlet  of  said 
sewer  system  is  located. 

§  78.  Permission  to  discharge  refuse  or  waste  matter 
from  industrial  establishments. —  Upon  application  duly 
made  to  the  state  commissioner  of  health  by  the  pro- 
prietor, lessee  or  tenant  of  any  shop,  factory,  mill  or 
industrial  establishment  from  which  the  discharge  of 
refuse  or  waste  matter  into  any  of  the  waters  of  the 
state  is  otherwise  prohibited  by  section  seventy-six,  the 
state  commissioner  of  health  shall  have  power  to  con- 
sider the  case  of  the  said  shop,  factory,  mill  or  indus- 
trial establishment,  and  whenever  the  public  health  and 


POTABLE   WATEBS  45 

purity  of  the  waters  shall  warrant  it,  he  shall  issue  a 
permit  for  the  discharge  of  refuse  or  waste  matter  from 
such  shop,  factory,  mill  or  industrial  establishment  into 
any  of  the  waters  of  the  state,  and  may  stipulate  in  the 
permit  such  modifications,  regulations  and  conditions  as 
the  public  health  may  require.  Such  permit  before 
being  operative  shall  be  recorded  in  the  county  clerk's 
office  of  the  county  where  such  shop,  factory,  mill  or 
industrial  establishment  is  located  and  a  copy  of  such 
permit  shall  be  transmitted  by  the  state  commissioner 
cf  health  to  the  board  of  health  of  the  municipality 
wherein  the  outlet  discharging  refuse  or  waste  matter 
from  such  shop,  factory,  mill  or  industrial  establishment 
shall  be  located. 

§  79.  Plans  for  refuse  discharge  pipes  must  be  sub- 
mitted.—  Before  any  conduit  or  discharge  pipe,  or  other 
means  of  discharging  or  casting  any  refuse  or  waste 
matter  from  any  shop,  factory,  mill  or  industrial  estab- 
lishment not  constructed  or  in  process  of  construction 
on  May  seventh,  nineteen  hundred  and  three,  shall  be 
put  in  or  constructed  for  the  purpose  of  discharging 
any  refuse  or  waste  matter  therefrom  into  any  waters 
in  this  state,  the  plan  or  plans  therefor,  together  with 
a  statement  of  the  purpose  for  which  the  same  is  to  be 
used,  shall  be  submitted  to  the  commissioner.  If  the 
same  is  not  detrimental  to  the  public  health  he  shall 
issue  a  permit  therefor  to  the  applicant.  Xo  such  con- 
duit, discharge  pipe  or  other  means  of  discharging  or 
casting  any  refuse  or  waste  matter  from  any  such  shop, 
factory,  mill  or  establishment  into  any  of  the  waters  of 
this  state  shall  be  put  in  or  constructed  before  such 
permit  is  granted,  and  if  put  in  or  constructed,  the 
person  putting  in  or  constructing  or  maintaining  the 
same  shall  forfeit  to  the  people  of  the  state  five  dollars 
a  day  for  each  day  the  same  is  used  or  maintained  for 


46  THE  PUBLIC   HEALTH   LAW 

such  purpose,  to  be  collected  in  an  action  brought  by 
the  commissioner.  He  may  also  maintain  an  action  in 
the  name  of  the  people  to  restrain  a  violation  of  this 
section. 

§  80.  Revocation  of  permit. —  Every  such  permit  for 
the  discharge  of  sewage  from  a  sewer  system  or  for  the 
discharge  of  refuse  or  waste  matter  from  a  shop,  fac- 
tory, mill  or  industrial  establishment,  shall  when  neces- 
sary to  conserve  the  public  health,  be  revocable  or  sub- 
ject to  modification  or  change  by  the  state  commissioner 
of  health  on  due  notice  after  an  investigation  and  hear- 
ing and  an  opportunity  for  all  interested  therein  to  be 
heard  thereon  being  served  on  the  public  authorities  of 
the  municipality  owning  ana  maintaining  the  sewer 
system,  or  on  the  proprietor,  lessee  or  tenant  of  the 
shop,  factory,  mill  or  industrial  establishment.  The 
length  of  the  time  after  receipt  of  the  notice  within 
which  the  discharge  of  sewage  or  of  refuse  or  waste 
matter  shall  be  discontinued  may  be  stated  in  the  per- 
mit, but  in  no  case  shall  it  exceed  two  years  in  the  case 
of  a  sewer  system,  or  one  year  in  the  case  of  a  shop, 
factory,  mill  or  industrial  establishment,  and  if  the 
length  of  time  is  not  specified  in  the  permit,  it  shall  be 
one  year  in  the  case  of  a  sewer  system  and  six  months 
in  the  case  of  a  shop,  factory,  mill  or  industrial  estab- 
lisnment.  On  the  expiration  of  the  period  of  time  pre- 
scribed after  the  service  of  a  notice  of  revocation,  modi- 
fication or  change  from  the  state  commissioner  of  health, 
the  right  to  discharge  sewage  or  refuse  or  waste  matter 
into  any  of  the  waters  of  the  state  shall  cease  and 
terminate  and  the  prohibition  of  section  seventy-six  of 
this  article  against  such  discharge  shall  be  in  full  force 
as  though  no  permit  had  been  granted,  but  a  new  permit 
may  thereafter  again  be  granted  as  hereinbefore  pro- 
vided. 


POTABLE   WATERS  47 

§  81.  Reports  of  municipal  authorities  to  local  boards 
of  health. —  The  report  of  the  public  authorities  having 
by  law  charge  of  the  sewer  system  of  every  municipality 
in  the  state,  from  which  sewer  system  sewage  was  being 
discharged  into  any  of  the  waters  of  the  state  on  May 
seventh,  nineteen  hundred  and  three,  transmitted  by  the 
board  of  health  of  the  municipality  within  which  any 
sewer  outlet  of  the  said  sewer  system  is  located  to  the 
state  commissioner  of  health  and  filed  by  him  in  his 
office,  shall  constitute  the  evidence  of  exemption  from 
the  prohibition  of  section  seventy-six  of  this  article.  No 
sewer  system  shall  he  exempt  from  the  prohibition  of 
said  section  against  the  discharge  of  sewage  into  the 
waters  of  the  state  for  which  a  satisfactory  report  shall 
not  have  been  filed  in  the  office  of  the  state  commissioner 
of  health  in  accordance  with  laws  of  nineteen  hundred 
and  three,  chapter  four  hundred  and  sixty-eight. 

§  82.  Reports  of  proprietors  of  industrial  establish- 
ments.—  The  report  of  the  proprietor  of  every  shop, 
factory,  mill  and  industrial  establishment  in  the  state, 
from  which  refuse  or  waste  matter  was  being  discharged 
into  any  of  the  waters  of  the  state  on  May  seventh,  nine- 
teen hundred  and  three,  filed  in  the  office  of  the  state 
commissioner  of  health  shall  constitute  the  evidence  of 
exemption  of  the  shop,  factory,  mill  or  industrial  estab- 
lishment from  the  prohibition  of  section  seventy-six  of 
this  article.  iN'o  shop,  factory,  mill  or  industrial  estab- 
lishment shall  be  exempt  from  the  prohibition  of  said 
section  against  the  discharge  of  refuse  or  waste  matter 
into  the  waters  of  the  state,  for  which  a  report  shall 
not  have  been  made  in  accordance  with  laws  of  nineteen 
hundred  and  three,  chapter  four  hundred  and  sixty- 
eight. 

§  83.  Record  of  permits;  inspection  of  local  boardi 
of  health. —  Each  board  of  health  shall  preserve  in  its 


48  THE   PUBLIC    HEALTH    LAW 

office  and  in  a  form  to  be  prescribed  by  the  state  com- 
missioner of  health,  a  permanent  record  of  each  permit 
issued  by  the  state  commissioner  of  health  granting  the 
right  to  discharge  sewage  or  refuse  or  waste  matter  into 
any  of  the  waters  of  the  state  within  that  municipality 
and  of  each  revocation  of  a  permit ;  and  also  a  perma- 
nent record  of  each  report  received  by  the  board  of 
health  concerning  each  sewer  system  and  each  shop, 
factory,  mill  or  industrial  establishment  which  on  May 
seventh,  nineteen  hundred  and  three,  was  discharging 
sewage  or  refuse  or  waste  matter  into  any  of  the  waters 
of  the  state  within  that  municipality.  Each  local  board 
of  health  shall  make  and  maintain  such  inspection  as 
will,  at  all  times,  enable  it  to  determine  whether  section 
seventy-six  of  this  article  is  being  complied  with  in 
respect  to  the  discharge  of  sewage,  refuse  or  waste  mat- 
ter or  other  materials  prohibited  by  said  section,  into 
any  of  the  waters  of  the  state  within  that  municipality. 
For  the  purpose  of  such  inspection  every  member  of 
such  board  of  health,  or  its  health  officers,  or  any  person 
duly  authorized  by  it,  shall  have  the  right  to  make  all 
necessary  examinations  of  any  premises,  building,  shop, 
factory,  mill,  industrial  establishment,  process  or  sewer 
system. 

§  84.  Violations;  service  of  notice;  actions  by  local 
boards. —  The  local  board  of  health  of  each  municipality 
shall  promptly  ascertain  every  A'iolation  of,  or  non-com- 
pliance with,  any  of  the  provisions  of  section  seventy- 
six  of  this  article  or  of  the  permits  for  the  discharge  of 
sewage  or  refuse  or  waste  material  into  any  of  the  waters 
of  the  state  herein  provided,  which  may  occur  within 
that  municipality.  The  board  of  health  shall  on  the 
discovery  of  every  violation  of  or  non-compliance  with 
any  of  the  provisions  of  said  section  or  of  any  permit 
duly  issued,  serve  a  written  notice  on  the  person  or  cor- 


POTABLE  WATEKS  49 

poration  responsible  for  the  violation  or  non-compliance^ 
together  with  a  copy  of  sections  seventy-six  to  eighty-six, 
inclusive,  of  this  article,  and  of  the  permit,  if  any, 
violated  or  non-complied  with,  specifying  the  j^articular 
provision  being  violated  or  non-complied  with,  and  stipu- 
lating the  length  of  time  within  which  the  violation  or 
non-compliance  must  cease.  If  at  the  expiration  of  the 
stipulated  length  of  time,  the  violation  or  non-compli- 
ance shall  still  continue,  the  board  of  health  shall  at 
once  report  the  violation  or  non-compliance  to  the  state 
commissioner  of  health  who  shall  at  once  give  a  hearing 
to  and  take  the  proof  of  the  persons  charged  with  such 
violation  or  non-compliance  and  investigate  the  matter 
and  if  he  finds  a  violation  or  non-compliance  to  exist  he 
shall  at  once  certify  that  fact  to  the  board  of  health  of 
the  municipality,  which  shall  immediately  bring  an  ac- 
tion in  a  court  of  record,  which  action  shall  be  tried  in 
the  county  wherein  the  cause  of  action  arose  against  the 
person  or  corporation  responsible  for  the  violation  or 
the  non-compliance  for  the  recovery  of  the  penalties  in- 
curred and  for  an  injunction  against  the  continuation 
of  the  violation  or   the  non-compliance. 

§  85.  Penalties. —  The  penalty  for  the  discharge  of 
sewage  from  any  public  sewer  system  into  any  of  the 
waters  of  the  state  without  a  duly  issued  permit  for 
which  a  permit  is  required  by  this  article  shall  be  five 
hundred  dollars,  and  a  further  penalty  of  fifty  dollars 
per  day  for  each  day  the  offense  is  maintained.  The 
penalty  for  the  discharge  of  sewage  from  any  public 
sewer  system  into  any  of  the  waters  of  the  state  without 
filing  a  report  for  which  a  report  is  required  to  be  filed 
with  the  board  of  health  of  tlie  municipality  shall  be 
fifty  dollars.  The  penalty  fcr  the  discharge  of  refuse 
or  waste  matter  from  any  shop,  factory,  mill  or  indus- 

4 


50  THE  PUBLIC   HEALTH   LAW 

trial  establishment  for  which  a  permit  is  required  by 
this  article,  without  such  permit  shall  be  one  hundred 
dollars  and  ten  dollars  per  day  for  each  day  the  offense 
is  maintained.  The  penalty  for  the  discharge  of  refuse 
or  waste  matter  from  any  shop,  mill,  factory  or  indus- 
trial establishment,  without  filing  a  report  where  a  re- 
port is  required  by  this  article  to  be  filed  shall  be 
twenty-five  dollars  and  five  dollars  per  day  for  each  day 
the  offense  is  maintained.  The  penalty  for  discharging 
into  any  of  the  waters  of  the  state  any  other  matter 
prohibited  by  section  seventy-six  of  this  article,  besides 
that  specified  above,  shall  be  twenty-five  dollars  and  five 
dollars  per  day  for  each  day  the  offense  is  maintained. 

§  86.  Constructions  and  limitations  made  by  sections 
seventy-six  to  eighty-five,  inclusive. —  Nothing  in  sec- 
tions seventy-six  to  eighty-five  inclusive  shall  be  con- 
strued to  diminish  or  otherwise  to  modify  the  common 
law  rights  of  riparian  owners  in  the  quality  of  waters 
of  streams  covered  by  such  rights,  nor  in  the  case  of 
actions  brought  against  the  pollution  of  waters  to  limit 
their  remedy  to  indemnities. 

§  87.  Actions  by  municipalities  to  prevent  discharge 
of  sewage  into  waters. — Any  incorporated  city  or  village 
in  the  state  of  Xew  York,  which  has  made  such  provi- 
sion for  the  disposal  of  its  sewage  as  not  to  pollute  or 
contaminate  therewith  any  river-,  stream,  lake  or  other 
body  of  water  may  have  and  maintain  an  action  in  the 
supreme  court  to  prevent  the  discharge  of  any  sewage 
or  substance  deleterious  to  health,  or  w^hich  shall  injure 
the  potable  qualities  of  the  water  in  any  river,  stream, 
lake  or  other  body  of  water,  from  which  such  incorpo- 
rated city  or  village  shall  take  or  receive  its  water  sup- 
ply, provided,  that  ^uch  river,  stream,  lake  or  other 
body  of  water  is  wholly,  or  in  part,  within  the  bounda- 
ries of  the   county  in   which  such   plaintiff   is   located. 


POTABLE   WATERS  51 

WHienever  such  action  sliall  be  brought  under  the  pro- 
visions of  this  section,  it  shall  be  the  duty  of  the  su- 
preme court  upon  proof  of  the  existence  of  fa<;ts 
justifying  the  bringing  and  maintenance  of  such  action 
under  the  provisions  of  this  section  to  render  a  judg- 
ment in  which  shall  be  incorporated  a  mandatory  in- 
junction requiring  the  person,  body,  board,  corporation, 
municipality,  village,  county  or  town,  being  a  defendant 
to  said  action  which  directly  or  indirectly  or  by  its 
servants,  agents  or  officers  shall  discharge  or  dispose 
of  its  sewage,  or  any  other  substance  deleterious  to 
health  or  which  shall  injure  the  potable  qualtities  of 
the  water  in  such  wise  as  that  the  same  shall  enter  into 
any  river,  stream,  lake  or  other  body  of  water,  from 
which  such  plaintiff  shall  take  or  receive  its  water  sup- 
ply, within  such  reasonable  time  as  may  be  prescribed 
by  the  court,  to  take  such  action  as  shall  prevent  such 
discharge  or  the  disposal  of  such  sewage  or  other  sub- 
stance into  such  waters,  or  the  pollution  thereof,  with 
such  further  directions  in  the  premises  as  may  be  proper 
and  desirable  to  effect  such  purpose,  provided  that  such 
river,  stream,  lake  or  other  body  of  water  is  wholly,  or 
in  part,  within  the  boundaries  of  the  county  in  which 
such  plaintiff  is  located.  But  no  such  action  shall  be 
brought  as  provided  for  in  this  section  until  the  state 
department  of  health  has  examined  and  determined 
whether  the  sewage  does  pollute  or  contaminate  the 
river,  stream,  lake  or  other  body  of  water  into  which 
said  sewage  is  discharged.  Tlie  expense  of  such  examin- 
ation by  said  department  shall  be  a  charge  upon  and 
paid  by  the  municipality  in  whose  interest,  and  on  whose 
behalf  such  examination  is  made.  In  case  the  state  de- 
partment of  health  shall  find  upon  examination  that  the 
discharge  of  said  sewage  does  pollute  or  contaminate 
said  waters  or  any  of  them  in  such  manner  as  to  be  of 
menace   or    danger   to   the   health    of    those   using   said 


52  THE   PUBLIC   HEALTH    LAW 

waters,  the  plans  for  the  removal  or  disposal  of  th. 
sewage  ordered  to  be  prepared  by  the  court  as  providec 
in  this  section  shall  be  submitted  to  the  state  depart 
ment   of   health   for   its   approval. 


ARTICLE  XVI 

Preservation  of  Life  and  Health 

Section  310.  Vaccination  of   school  children    (p.  53). 
311.  Appointment  of   physician. 

313.  Examination  and  quarantine  of  children  ad 

mitted  to  institutions  for  orphan,  desti- 
tute or  vagrant  children  or  juvenile  delin- 
quents  (p.  54). 

314.  Monthly  examination  of  inmates  and  reports. 

315.  Beds:  ventilation. 

319.  C'on.sents  requisite    to   the  establishment   of 

hospitals  or  camps  for  the  treatment  of 
pulmonary  tuberculosis    (p.   56). 

320.  Reports  of  tuberculosis   by    pliysicians   and 

others    (p.   5S). 

321.  Examination   of     sputum    (p.  59). 

322.  Protection  of  records   (p.  59). 

323.  Disinfection    of   premises    (p.    60). 

324.  Health  officer  to  direct  disinfection,  cleans- 

ing or  renovation    (p.  60). 

325.  Prohibiting  occupancy  until  order  of  health 

officer  is  complied  with  (p.  61). 

326.  Prohibiting  carelessness  of  a  person  hiving 

tuberculosis    (p.    62). 

327.  Protection    of  patient's  family  (p.  62). 

328.  Providing    that    physicians    shall    make    a 

complete  statement  of  procedure  and  pre- 
cautions on  a  blank  to  be  furnished  by 
the  health  officer    (p.  63). 


VACCI>'ATI0X    OF   SCHOOL  CHILDREN  53 

Section  329.  Penalty  for  failure  of  phvsiciau  to  perform 
duties  or  for  making  false  reports  (p. 
65). 

330.  Reporting    recoverr   of  patient    ip.  05). 

331.  General     penaltv   (p.   60). 
33'2.  Application  of  provisions. 

§  310.  Vaccination  of  school  children. —  Xo  child  or 
person  not  vaccinated  shall  be  admitted  or  received  into 
any  of  the  public  schools  of  the  state,  and  the  trustees 
or  other  officers  having  the  charge,  management  or  con- 
trol of  such  schools  shall  cause  this  provision  of  law  to 
be  enforced.  Tliey  may  adopt  a  resoltition  excluding 
such  children  and  persons  not  vaccinated  from  such 
school  until  vaccinated,  and  when  any  such  resolution 
has  been  adopted,  they  shall  give  at  least  ten  days' 
notice  thereof,  by  posting  copies  of  the  same  in  at  least 
two  public  and  conspicuous  places  within  the  limits  of 
the  school  government,  and  shall  announce  therein  that 
due  provision  has  been  made,  specifying  it,  for  the  vac- 
cination of  any  child  or  person  of  stiitable  age  desiring 
to  attend  the  school,  and  whose  parents  or  guardians 
are  unable  to  procure  vaccination  for  them,  or  who  are, 
by  reason  of  poverty,  exempted  from  taxation  in  such 
district. 

§  311.  Appointment  of  physician. —  Such  trustees  or 
board  may  appoint  a  competent  physician  and  fix  his 
compensation,  who  shall  ascertain  the  number  of  children 
or  persons  in  a  school  district,  or  in  a  subdivision  of  a 
city  school  government,  of  suitable  age  to  attend  the 
common  schools,  who  have  not  been  vaccinated  and  fur- 
nish such  trustees  or  board  a  list  of  their  names.  Every 
such  physician  shall  provide  himself  with  good  and  re- 
liable vaccine  virus  with  which  to  vaccinate  such  chil- 
dren or  persons  as  such  trustees  or  board  shall  direct. 
and  give  certificates  of  vaccination  when  required,  which 


54  THE   PUBLIC    HEALTH   LAW 

shall  be  evidence  that  the  child  or  person  to  whom  given 
has  been  vaccinated.  The  expenses  incurred  in  carrying 
into  effect  the  revisions  of  this  and  the  preceding  sec- 
tion, shall  be  deemed  a  part  of  the  expense  of  maintain- 
ing such  school,  and  shall  be  levied  and  collected  in  the 
same  manner  as  other  school  expenses.  The  trustees  of 
the  several  school  districts  of  the  state  shall  include  in 
their  annual  report  the  number  of  vaccinated  and  unvac- 
cinated  children  of  school  age  in  their  respective 
districts. 

§  313.  Examination  and  quarantine  of  children  ad- 
mitted to  institutions  for  orphan,  destitute  or  vagrant 
children  or  juvenile  delinquents. —  Every  institution  in 
this  state,  incorporated  for  the  express  purpose  of  re- 
ceiving or  caring  for  orphan,  vagrant  or  destitute  chil- 
dren or  juvenile  delinquents,  except  hospitals,  shall  have 
attached  thereto  a  regular  physician  of  its  selection 
duly  licensed  under  the  laws  of  the  stat^  and  in  good 
professional  standing,  whose  name  and  address  shall  be 
kept  posted  conspicuously  within  such  institution  near 
its  main  entrance.  The  words  "  juvenile  delinquents " 
here  used  shall  include  all  children  whose  commitment 
to  an  institution  is  authorized  by  the  penal  law.  The 
officer  of  every  such  institution  upon  receiving  a  child 
therein,  by  commitment  or  otherwise,  shall,  before  ad- 
mitting it  to  contact  with  the  other  inmates,  cause  it 
to  be  examined  by  such  physician,  and  a  written  cer- 
tificate to  be  given  by  him,  stating  whether  the  child 
has  diphtheria,  scarlet  fever,  measles,  whooping  cough 
or  any  other  contagious  or  infectious  disease,  especially 
of  the  eyes  and  skin,  which  might  be  communicated  to 
other  inmates  and  specifying  the  physical  and  mental 
condition  of  the  child,  the  presence  of  any  indication 
of  hereditary  or  other  constitutional  disease,  and  any 
deformity    or    abnormal    condition    found   upon   the    ex- 


INSTITUTIONS   FOE   CHILDEEN  55 

amination  to  exist.  Xo  child  shall  be  so  admitted  until 
such  certificate  shall  have  been  furnished,  which  shall 
be  filed  with  the  commitment  or  other  papers  on  record 
in  the  case,  by  the  officers  of  the  institution,  who  shall, 
on  receiving  such  child,  place  it  in  strict  quarantine 
thereafter  from  the  other  inmates,  until  discharged  from 
such  quarantine  by  such  physician,  who  shall  thereupon 
indorse  upon  the  certificate  the  length  of  quarantine 
and  the  date  of  discharge  therefrom. 

§  314.  Monthly  examination  of  inmates  and  reports. — 
Such  physician  shall  at  least  once  a  month  thoroughly 
examine  and  inspect  the  entire  institution,  and  report 
in  writing,  in  such  form  as  may  be  approved  by  the 
state  board  of  health,  to  the  board  of  managers  or 
directors  of  the  institution,  and  to  the  local  board  of 
the  district  or  place  where  the  institution  is  situated, 
its  condition,  especially  as  to  its  plumbing,  sinks,  water- 
closets,  urinals,  privies,  dormitories,  the  physical  con- 
dition of  the  children,  the  existence  of  any  contagious 
or  infectious  disease,  particularly  of  the  eyes  or  skin, 
their  food,  clothing  and  cleanliness,  and  whether  the 
officers  of  the  institution  have  provided  proper  and  suffi- 
cient nurses,  orderlies,  and  other  attendants  of  proper 
capacity  to  attend  to  such  children,  to  secure  to  them 
due  and  proper  care  and  attention  as  to  their  personal 
cleanliness  and  health,  with  such  recommendations  for 
the  improvement  thereof  as  he  may  deem  proper.  Such 
boards  of  health  shall  immediately  investigate  any  com- 
plaint against  the  management  of  the  institution  or  of 
the  existence  of  anything  therein  dangerous  to  life  or 
health,  and,  if  proven  to  be  well  founded,  shall  cause 
the  evil  to  be  remedied  without  delay. 

§  315.  Beds;   ventilation. —  The  beds  in  every  dormi- 
tory in  such  institution  shall  be  separated  by  a  passage- 


5G  THE   PUBLIC    HEALTH    LAW 

way  of  not  less  than  two  feet  in  width,  and  so  arranged 
tliat  under  each  the  air  shall  freely  circulate  and  there 
shall  be  adequate  yentilation  of  each  bed,  and  such 
dormitory  shall  be  furnished  ^yith  such  means  of  venti- 
lation as  the  local  board  of  health  shall  prescribe.  In 
every  dormitory  six  hundred  cubic  feet  of  air  space  shall 
be  provided  and  allowed  for  each  bed  or  occupant,  and 
no  more  beds  or  occupants  shall  be  permitted  than  are 
thus  provided  for,  unless  free  and  adequate  means  of 
ventilation  exist  approved  by  the  local  board  of  health, 
and  a  special  permit  in  writing  therefor  be  granted  by 
such  board,  specifying  the  number  of  beds  or  cubic  air 
space  which  shall,  under  special  circumstances,  be  al- 
lowed, which  permit  shall  be  kept  conspicuously  posted 
in  such  dormitory.  The  physician  of  the  institution 
shall  immediately  notif}'  in  writing  the  local  board  of 
health  and  the  board  of  managers  or  directors  of  the 
institution  of  any  violation  of  any  provision  of  this 
section. 

§  319.  Consents  requisite  to  the  establishment  of 
hospitals  or  camps  for  the  treatment  of  pulmonary 
tuberculosis. —  A  hospital,  camp  or  other  establishment 
for  the  treatment  of  patients  suffering  from  the  disease 
known  as  pulmonary  tuberculosis,  shall  not  be  estab- 
lished in  any  town  by  any  person,  association,  corpora- 
tion or  municipality  except  when  authorized  as  provided 
by  this  section.  The  person,  association,  corporation  or 
municipality  proposing  to  establish  such  a  hospital, 
camp  or  other  establishment  shall  file  with  the  state 
commissioner  of  health  a  petition  describing  the  char- 
acter thereof,  stating  the  county  and  town  in  w^hich  it 
is  to  Ije  located  and  describing  the  site  in  such  town 
for  such  proposed  hospital,  camp  or  other  establishment, 
and  requesting  the  commissioner  to  fix  a  date  and  place 
for  a  hearing  on  such  petition  before  the  state  commis- 


TTJBEECULOSIS   HOSPITAL  SITES  57 

sioner  of  health  and  the  local  health  officer,  who  shall 
constitute  a  board  to  approve  or  disapprove  the  estab- 
lishment of  such  hospital,  camp  or  other  establishment 
in  accordance  with  such  petition.  The  state  commis- 
sioner of  health  shall  fix  a  date  and  place  for  a  hearing 
on  such  petition,  which  date  shall  be  not  less  than  thirtj 
nor  more  than  forty  days  after  the  receipt  thereof.  A 
notice  of  such  hearing  specifying  the  date  and  place 
thereof  and  briefly  describing  the  proposed  site  for  such 
hospital,  camp  or  other  establishment  shall  be  mailed 
to  the  person,  association,  corporation  or  municipality 
proposing  to  establish  the  same  and  to  the  health  officer 
and  each  member  of  the  board  of  health  of  the  town  in 
which  it  is  proposed  to  establish  such  hospital,  camp  or 
other  establishment  at  least  twenty  days  before  the 
hearing,  and  also  "^publish  twice  in  a  local  newspaper 
of  the  town,  or  if  there  is  no  such  paper  published 
therein,  then  in  the  newspapers  of  the  county  designated 
in  pursuance  of  law  to  publish  the  session  laws.  At 
the  time  and  place  fixed  for  such  hearing  the  state  com- 
missioner of  health  and  the  local  health  officer  shall 
hear  the  petitioner  and  any  person  who  desires  to  be 
heard  in  reference  to  the  location  of  such  hospital,  camp 
or  other  establishment,  and  they  shall  within  thirty  days 
after  the  hearing,  if  they  are  able  to  agree,  approve  or 
disapprove  of  the  location  thereof  and  shall  notify  the 
person,  association,  corporation  or  municipality  of  their 
determination.  The  determination  of  the  state  commis- 
sioner of  health  and  local  health  officer  shall  be  final 
and  conclusive:  but  if  within  thirty  days  after  the  hear- 
ing they  are  unable  to  agree,  they  shall  within  such 
thirty  days  notify  the  person,  association,  corporation 
or  municipality  proposing  to  establish  such  hospital, 
camp   or    other    establishment    that    they    are   unable   to 

^  So   in   original. 


68  THE  PUBLIC   HEALTH   LAW 

agree.  Within  ten  days  after  the  receipt  of  such  notice, 
such  person,  association,  corporation  or  municipality 
may  file  in  the  office  of  the  state  commissioner  of  health 
a  request  that  the  petition  be  referred  to  a  board  con- 
sisting of  the  lieutenant-governor,  the  speaker  of  the 
assembly  and  the  state  commissioner  of  health.  Such 
officers  shall  approve  or  disapprove  of  the  proposed  loca- 
tion of  such  hospital,  camp  or  other  establishment  after 
a  hearing  of  which  notice  shall  be  mailed  to  the  person, 
association,  corporation  or  municipality  proposing  to  es- 
tablish the  same  and  to  the  health  officer  and  to  each 
member  of  the  board  of  health  of  the  town,  or  without 
a  hearing,  upon  the  evidence,  papers  and  documents  filed 
with  the  state  commissioner  of  health  or  that  may  be 
submitted  to  them,  as  the  board  shall  determine.  They 
shall  make  their  determination  within  thirty  days  after 
the  request  for  such  submission  has  been  filed  in  the 
office  of  the  state  commissioner  of  health  and  cause  a 
copy  thereof  to  be  mailed  to  the  person,  association,  cor- 
poration or  municipality  proposing  to  establish  such 
hospital,  camp  or  other  establishment  and  to  the  health 
officer  of  the  town  in  which  it  is  proposed  to  establish 
the  same.  Such  determination  shall  be  final  and  con- 
clusive. 

§  320.  Reports  of  tuberculosis  by  physicians  and 
others. —  Tuberculosis  is  hereby  declared  to  be  an  in- 
fectious and  communicable  disease,  dangerous  to  the 
public  health.  It  shall  be  the  duty  of  every  physician 
in  the  state  of  New  York,  to  report  in  writing,  on  a 
form  to  be  furnished  as  hereinafter  provided,  the  name, 
age,  sex,  color,  occupation,  place  where  last  employed, 
if  known,  and  address,  of  every  person  known  by  said 
physician  to  have  tuberculosis,  to  the  health  officer  of 
the  city,  town  or  village  in  which  said  person  resides, 
within  twenty-four  hours  after  such  fact  comes  to  the 


TUBEKCULOSIS  LAW  59 

knowledge  of  said  physician.  It  shall  also  be  the  duty 
of  the  chief  officer  having  charge  for  the  time  being  of 
any  hospital,  dispensary,  asylum  or  other  similar  pri- 
vate or  public  institution  in  said  state  of  New  York 
to  report  in  like  manner  the  name,  age,  sex,  color, 
occupation,  place  where  last  employed  if  known,  and 
previous  address  of  every  patient  having  tuberculosis 
who  comes  into  his  care  or  under  his  observation, 
within  twenty-four  hours  thereafter. 

§  321.  Examination  of  sputum.— It  shall  be  the  duty 
of  every  health  officer  of  a  city,  town  or  village,  when 
so  requested  by  any  physician,  or  by  authorities  of  any 
hospital  or  dispensary  to  make  or  cause  to  be  made 
a  microscopical  examination  of  the  sputum  forwarded 
to  him  as  that  of  a  person  having  symptoms  of  tuber- 
culosis, which  shall  be  forwarded  to  such  officer  accom- 
panied by  a  blank  giving  name,  age,  sex,  color,  occupa- 
tion, place  where  last  employed  if  known,  and  address 
of  the  person  whose  sputum  it  is.  It  shall  be  the  duty 
of  said  health  officer  promptly  to  make  a  report  of  the 
results  of  such  examination,  free  of  charge,  to  the  physi- 
cian or  person  upon  whose  application  the  same  is  made. 

§  322.  Protection  of  records. —  It  shall  be  the  duty 
of  every  health  officer  of  a  city,  town  or  village  to  cause 
all  reports  made  in  accordance  with  the  provisions  of 
section  three  hundred  and  twenty,  and  also  all  results 
of  examinations  showing  the  presence  of  the  bacilli  of 
tuberculosis,  made  in  accordance  with  the  provisions  of 
section  three  hundred  and  twenty-one,  to  be  recorded  in 
a  register,  of  which  he  shall  be  the  custodian.  Such 
register  shall  not  be  open  to  inspection  by  any  person 
other  than  the  health  authorities  of  the  state  and  of 
the  said  city,  town  or  village,  and  said  health  authori- 
ties shall  not  permit  any    ■^uch  report  or  record  to  be 


60  THE   PUBLIC   HEALTH   LAW 

divulged  so  as  to  disclose  the  identity  of  the  i>erson 
whom  it  relates,  exce^Dt  as   may  be   necessary   to   can 
into  effect  the  provisions  of  this  article. 

§  323.  Disinfection  of  premises. —  In  case  of  the  vac? 
tion  of  any  apartment  or  premises  by  the  death  or  r 
moval  therefrom  of  a  person  having  tuberculosis,  it  sha 
be  the  duty  of  the  attending  physician,  or  if  there  be  r 
such  physician,  or  if  such  physician  be  absent,  of  tl 
owner,  lessee,  occupant,  or  other  person  having  chare 
of  the  said  apartments  or  premises,  to  notify  the  healt 
officer  of  said  city,  town  or  village,  of  said  death  or  n 
moval  within  twenty-four  hours  thereafter,  and  sue 
apartments  or  premises  so  vacated  shall  not  again  I 
occupied  until  duly  disinfected,  cleansed  or  renovated  a 
hereinafter  provided. 

§  324.  Health  officer  to  direct  disinfection,  cleansinj 
or  renovation.— Wlien  notified  of  the  vacation  of  an: 
apartments  or  premises  as  provided  in  section  thre 
hundred  and  twenty-three  thereof,  the  local  health  office 
or  one  of  his  assistants  or  deputies,  shall  within  twenty 
four  hours  thereafter  visit  said  apartments  or  premise 
and  shall  order  and  direct  that,  except  for  purposes  o 
cleansing  or  disinfection,  no  infected  article  shall  b 
removed  therefrom  until  properly  and  suitably  cleansec 
or  disinfected,  and  said  health  officer  shall  determin 
the  manner  in  which  such  apartments  or  premises  shal' 
be  disinfected,  cleansed  or  renovated  in  order  that  thei 
may  be  rendered  safe  and  suitable  for  occupancy.  I 
the  health  authorities  determine  that  disinfection  ii' 
sufficient  to  render  them  safe  and  suitable  for  occupancy' 
such  apartments  or  premises  together  with  all  infectec 
articles  therein,  shall  immediately  be  disinfected  by  thc^ 
health  authorities  at  public  expense,  or  provided,  how- 
ever, that  in  any  locality  which  in  the  judgment  of  the 


TUBEECULOSIS   LAW  61 

ate  commissioner  of  health  may  be  considered  a  resort 
r   persons  having   tuberculosis,    such   disinfection   may 

the  discretion  of  the  health  authorities  be  done  by 
.ch  health  authorities  at  the  expense  of  the  owner  of 
e  premises.  Should  the  health  authorities  determine 
at  such  apartments  or  premises  are  in  need  of  thor- 
Lgh  cleansing  and  renovation,  a  notice  in  writing  to 
is  effect  shall  be  served  upon  the  owner  or  agent  of 
id  apartments  or  premises,  and  said  owner  or  agent 
all  thereupon  proceed  to  the   cleansing  or   renovating 

such  apartments  or  premises  in  accordance  with  the 
structions  of  the  health  authorities,  and  such  cleansing 
id  renovation  shall  be  done  at  the  expense  of  the  said 
fner  or  asent.  In  anv  case  in  which  the  owner  is 
ible  for  the  expense  of  such  disinfection,  cleansing  or 
novation  by  or  pursuant  to  the  provisions  of  this  sec- 
Dn,  such  expense  if  not  paid  shall  be  a  first  lien  upon 
ch  property,  real  or  personal,  so  disinfected,  cleansed 

renovated,  having  preference  over  all  other  liens  and 
cumbrances  whatever.  If  the  lien  is  against  real 
operty,  it  may  be  foreclosed  in  the  manner  prescribed 

section  thirty-two  of  the  public  health  law;  if  the 
!n   is  against    personal   property  it   may   be   foreclosed 

the  manner  prescribed  in  sections  two  hundred  and 
s  to  two  hundred  and  nine,  inclusive,  of  the  lien  law. 

§  325.  Prohibiting  occupancy  until  order  of  health 
Seer  is  complied  with. —  In  case  the  orders  or  direc- 
3ns  of  the  local  health  officer  requiring  the  disinfec- 
3n,  cleansing  or  renovation  of  any  apartments  or 
emises  or  any  articles  therein  as  hereinbefore  pro- 
ded,  shall  not  be  complied  with  within  forty-eight 
)urs  after  such  orders  or  directions  shall  be  given, 
e  health  officer  may  cause  a  placard  in  words  and 
rm  substantially  as  follows  to  be  placed  upon  the 
►or  of  the  infected  apartments  or  premises: 


62  THE   PUBLIC    HEALTH   LAW 

"  Tuberculosis  is  a  communicable  disease.  These 
apartments  have  been  occupied  by  a  consumptive  and 
may  be  infected.  They  must  not  be  occupied  until  the 
order  of  the  health  officer  directing  their  disinfection  or 
renovation  has  been  complied  with.  This  notice  must 
not  be  removed  under  the  penalty  of  the  law  except  by 
the  health  officer  or  other  duly  authorized  official." 

§  326.  Prohibiting  carelessness  of  a  person  having 
tuberculosis. —  Any  person  having  tuberculosis  who  shall 
dispose  of  his  sputum^  saliva  or  other  bodily  secretion 
or  excretion  so  as  to  cause  offense  or  danger  to  any 
person  or  persons  occupying  the  same  room  or  apart- 
ment, house  or  part  of  a  house,  shall  on  complaint  of 
any  person  or  persons  subjected  to  such  offense  or  dan- 
ger, be  deemed  guilty  of  a  nuisance  and  any  persons 
subjected  to  such  a  nuisance  may  make  complaint  in 
person  or  writing  to  the  health  officer  of  any  city,  town, 
or  village  where  the  nuisance  complained  of  is  com- 
mitted. And  it  shall  be  the  duty  of  the  local  health 
officer  receiving  such  complaint  to  investigate  and  if 
it  appears  that  the  nuisance  complained  of  is  such  as 
to  cause  ofTense  or  danger  to  any  person  occupying  the 
same  room,  apartment,  house  or  part  of  a  house,  he 
shall  serve  a  notice  upon  the  person  so  complained  of, 
reciting  the  alleged  cause  of  offense  or  danger  and  re- 
quiring him  to  dispose  of  his  sputum,  saliva  or  other 
bodily  secretion  or  excretion  in  such  a  manner  as  to 
remove  all  reasonable  cause  of  offense  or  danger.  Any 
person  failing  or  refusing  to  comply  with  orders  or  regu- 
lations of  the  local  health  officer  of  any  city,  town  or 
village,  requiring  him  to  cease  to  commit  such  nuisance, 
shall  be  deemed  guilty  of  a  misdemeanor  and  on  convic- 
tion thereof  shall  be  fined  not  more  than  ten  dollars. 

§  327.  Protection  of  patient's  family.— It  shall  be 
the   duty    of   a   physician   attending    a   patient   having 


TUBEBCHLOSIS   LAW  60 

tuberculosis  to  take  all  proper  precautions  and  to  give 
proper  instructions  to  provide  for  the  safety  of  all  in- 
dividuals occupying  the  same  house  or  apartment,  and 
if  no  physician  be  attending  such  patient  this  duty  shall 
devolve  upon  the  local  health  officer,  and  all  duties  im- 
posed upon  physicians  by  any  sections  of  this  article 
shall  be  performed  by  the  local  health  officer  in  all  cases 
of  tuberculosis  not  attended  by  a  physician,  or  when  the 
physician  fails  to  perform  the  duties  herein  specified, 
and  shall  so  report. 

§  328.  Providing  that  physicians  shall  make  a  complete 
statement  of  procedure  and  precautions  on  a  blank  to 
be  furnished  by  the  health  officer. —  It  shall  be  the 
duty  of  the  local  health  officer  to  transmit  to  a  physi- 
cian reporting  a  case  of  tuberculosis  as  provided  in  sec- 
tion three  hundred  and  twenty,  a  printed  statement  and 
report,  in  a  form  approved  by  the  state  commissioner 
of  health,  naming  such  procedure  and  precautions  as 
in  the  opinion  of  the  said  commissioner  are  necessary  or 
desirable  to  be  taken  on  the  premises  of  a  tuberculosis 
patient.  It  shall  be  the  duty  of  the  local  health  author- 
ities to  print  and  keep  on  hand  an  ample  supply  of  such 
statements  and  reports  and  to  furnish  the  same  in  suffi- 
cient numbers  to  all  local  physicians.  Upon  receipt  of 
such  statement  and  report  the  physician  shall  either 
carry  into  effect  all  such  procedures  and  precautions  as 
are  therein  prescribed,  and  shall  thereupon  sign  and 
date  the  same  and  return  it  to  the  local  health  officer 
without  delay,  or,  if  such  attending  physician  be  un- 
willing or  unable  to  carry  into  effect  the  procedures  and 
precautions  specified,  he  shall  so  state  upon  this  report 
and  immediately  return  the  same  to  the  local  health 
officer  and  the  duties  therein  prescribed  shall  thereupon 
devolve  upon  said  local  health  officer  who  shall  receive 
the  fee  hereinafter  provided  as  payment  of  the  services 


64  THE   PUBLIC    HEALTH    LAW 

of  the  physician  if  he  comply  with  the  duties  herein, 
prescribed.  Upon  receipt  of  this  statement  and.  report 
the  local  health  officer  shall  carefully  examine  the  same, 
and  if  satisfied  that  the  attending  physician  has  taken 
all  necessary  and  desirable  precautions  to  insure  the 
safety  of  all  persons  living  in  the  apartments  or  prem- 
ises occupied  by  the  person  having  tuberculosis,  the  said 
local  health  officer  shall  issue  an  order  upon  the  treas- 
urer of  the  city,  town  or  village  in  favor  of  the  attend- 
ing physician,  except  where  such  physician  is  employed 
by  and  receives  a  salary  from  the  state  of  Xew  York,  for 
the  sum  of  one  dollar,  thereupon  to  be  paid  out  of  a 
fund  which  shall  l^e  provided  by  said  city,  town,  or  vil- 
lage. If  the  precautions  taken  or  instructions  given  by 
the  attending  physician  are,  in  the  opinion  of  the  local 
health  officer,  not  such  as  will  remove  all  reasonable 
danger  or  probability  of  danger  to  the  persons  occupying 
the  said  house  or  apartments  or  premises,  the  local 
health  officer  shall  return  to  the  attending  physician 
the  report  with  a  letter  specifying  the  additional  pre- 
cautions or  instructions  which  the  health  officer  shall 
require  him  to  take  or  give;  and  the  said  attending 
physician  shall  immediately  take  the  additional  pre- 
cautions and  give  the  additional  instructions  specified 
and  shall  record  and  return  the  same  on  the  original 
report  to  the  local  health  officer.  It  shall  further  be 
the  duty  of  the  local  health  officer  to  transmit  to  the 
physician  reporting  any  case  of  tuberculosis  a  printed 
requisition,  in  a  form  approved  by  the  state  commis- 
sioner of  health,  and  printed  by  the  local  health  author- 
ities and  issued  in  sufficient  number  to  supply  local 
physicians.  Upon  this  requisition  blank,  shall  be  named 
the  materials  kept  on  hand  by  the  local  health  officer 
for  the  prevention  of  the  spread  of  tuberculosis  and  it 
shall  be  the  duty  of  the  local  health  officer  to  supply 
such  materials  as  may  be  specified  in  such  requisition. 


TUBEBCULOSIS   lAW  65 

Any  physician  may  return  a  duly  signed  requisition  to 
the  local  health  officer  for  such  of  the  sj^ecified  materials 
and  in  such  amount  as  he  may  deem  necessary  to  aid 
dim  in  preventing  the  spread  of  a  disease,  and  all  local 
tiealth  officers  shall  honor,  as  far  as  possible,  the  requi- 
sition signed  by  the  attending  physician  in  such  case, 
[t  shall  be  the  duty  of  every  local  health  officer  to  trans- 
nit  to  every  physician  reporting  any  case  of  tubercu- 
osis,  or  to  the  person  reported  as  suflFering  from  this 
iisease,  provided  the  latter  has  no  attending  physician, 
i  circular  of  information  approved  by  the  state  com- 
nissioner  of  health  and  which  shall  be  provided  in  suffi- 
ient  quantity  by  the  local  health  authorities.  This  cir- 
ular  of  information  shall  inform  the  consumptive  of  the 
'est  methods  of  treatment  of  his  disease  and  of  the  pre- 
autions  necessary  to  avoid  transmitting  the  disease  to 
thers. 

§  329.  Penalty  for  failure  of  physician  to  perform 
uties  or  for  making  false  reports.— Any  physician  or 
erson  practicing  as  a  physician  who  shall  iknowingly 
^port  as  affected  with  tuberculosis  any  person  who  is 
ot  so  affected,  or  who  shall  wilfully  make  any  false 
tatement  concerning  the  name,  age,  sex,  color,  occupa- 
on,  place  where  last  employed  if  known,  or  address  of 
Qy  person  reported  as  affected  with  tuberculosis,  or 
ho  shall  certify  falsely  as  to  any  of  the  precautions 
iken  to  prevent  the  spread  of  infection,  shall  be  deemed 
lilty  of  a  misdemeanor,  and  on  conviction  thereof  shall 
J  subject  to  a  fine  of  not  more  than  one  hundred 
)llars. 

§  330.  Reporting  recovery  of  patient.— Upon  the  re- 
'very  of  any  person  having  tuberculosis,  it  shall  be  the 
ity  of  the  attending  physician  to  make  a  report  of  this 


66  THE  PUBLIC   HF.ATTH   LAW 

fact  to  the  local  health  officer,  who  shall  record  the  sanw 
in  the  records  of  his  office,  and  shall  relieve  said  persor 
from  further  liability  to  any  requirements  imposed  bj 
this  article. 

§  331.  General  penalty.—  Any  person  violating  any  ol 

the  provisions  of  sections  three  hundred  and  twenty  t( 
three  hundred  and  thirty,  both  inclusive,  of  this  article 
shall  be  deemed  guilty  of  a  misdemeanor  and  upon  con 
viction  thereof  shall  be  punished,  except  as  in  thi 
article  otherwise  provided,  by  a  fine  of  not  less  than  fiv- 
dollars  nor  more  than  fifty  dollars. 

§  332.  Application  of  provisions. —  No  portion  of  sec 

tions  three  hundred  and  twenty  and  three  hundred  an( 
thirty-one,  both  inclusive,  shall  apply  to  the  city  o 
Xew  York,  nor  shail  the  passage  of  said  sections  modif; 
or  repeal  any  of  the  provisions  of  the  charter  of  the  cit; 
of  New  York,  or  any  rule  or  regulation  issued  by  the  de 
partment  of  health  of  said  New  York  city. 


COUXTY   HOSPITALS   FOR   TTTBEECTILOSIS  67 

COUNTY    HOSPITALS   FOR  TUBERCULOSIS 

CHAP.   341,  LAWS  OF   1909 

An  Act  to  amend  the  county  law,  in  relation  to  the 
establishment  and  maintenance  of  county  hospitals 
for  the  care  of  persons  suffering  from  the  disease 
known  as  tuberculosis. 

§  45.  Establishment  of  county  hospital  for  tub- 
erculosis.—  The  board  of  supervisors  of  any  county 
shall  have  power  by  a  majority  vote  to  establish  a 
county  hospital  for  the  care  and  treatment  of  persons 
suffering  from  the  disease  known  as  tuberculosis.  When 
the  board  of  supervisors  of  any  county  shall  have  voted 
to  establish  such  hospital,  it  shall  have  the  following 
power : 

1.  To  purchase  and  lease  real  property  therefor,  or 
acquire  such  real  property,  and  easements  therein,  by 
condemnation  proceedings,  in  the  manner  prescribed  by 
the  condemnation  law,  in  any  town,  city  or  village  in 
the   county. 

2.  To  erect  all  necessary  buildings,  make  all  neces- 
sary improvements  and  repairs  and  alter  any  existing 
buildings,  for  the  use  of  said  hospital,  provided  that  the 
plans  for  such  erection,  alteration  or  repair  shall  iirst 
be  approved  by  the  state  commissioner  of  health. 

3.  To  cause  to  be  assessed,  levied  and  collected  such 
sums  of  money  as  it  shall  deem  necessary  for  suitable 
lands,  buildings  and  improvements  for  said  hospital,  and 
for  the  maintenance  thereof,  and  for  all  other  necessary 
expenditures  therefor;  and  to  borrow  money  for  the 
erection  of  such  hospital  and,  for  the  purchase  of  a  site 
therefor  on  the  credit  of  the  county,  and  issue  county 
obligations  therefor,  in  such  manner  as  it  may  do  for 
other  county  purposes. 

4.  To  appoint  a  board  of  managers  for  said  hospital 
as  hereinafter  provided. 


68  THE  PUBLIC   HEAXTH  LAW 

5.  To  accept  and  hold  in  trust  for  the  county,  any 
grant  or  devise  of  land,  or  any  gift  or  bequest  of  money 
or  other  personal  property  or  any  donation  to  be  ap- 
plied, principal  or  income,  or  both,  for  the  benefit  of 
said  hospital,  and  apply  the  same  in  accordance  with 
the  terms  of  the  gift. 

§  46.  Appointment  and  terms  of  office  of  managers. — 

When  the  board  of  supervisors  shall  have  determined  to 
establish  a  hospital  for  the  care  and  treatment  of  per- 
sons suffering  from  tuberculosis,  and  shall  have  ac- 
quired a  site  therefor,  and  shall  have  awarded  con- 
tracts for  the  necessary  buildings  and  improvements 
thereon,  it  shall  appoint  five  citizens  of  the  county,  of 
whom  at  least  two  shall  h€  practicing  j)liysicians,  who 
shall  constitute  a  board  of  managers  of  the  said  hos- 
pital. The  term  of  office  of  each  member  of  said  board 
shall  be  five  years,  and  the  term  of  one  of  such  managers 
shall  expire  annually;  the  first  appointments  shall  be 
made  for  the  respective  terms  of  five,  four,  three,  two 
and  one  years.  Appointments  of  successors  shall  be  for 
the  full  term  of  five  years,  except  that  appointment  of 
persons  to  fill  vacancies  occurring  by  death,  resignation 
or  other  cause  shall  be  made  for  the  unexpired  term. 
Failure  of  any  manager  to  attend  three  consecutive 
meetings  of  the  board  shall  cause  a  vacancy  in  this 
office,  unless  said  absence  is  excused  by  formal  action 
of  the  board  of  managers.  The  managers  shall  receive 
no  compensation  for  their  services,  but  shall  be  allowed 
their  actual  and  necessary  traveling  and  other  expenses, 
to  be  audited  and  paid,  in  the  same  manner  as  the  other 
expenses  of  the  hospital,  by  the  board  of  supervisors. 
Any  manager  may  at  any  time  be  removed  from  office 
by  the  board  of  supervisors  of  the  county,  for  cause  after 
an  opportunity  to  be  heard. 


COUNTY  TUBEECUIOSIS   HOSPITAIS  €9 

§  47.  General  powers  and  duties  of  managers. —  The 
^^ard  of  managers. 

1.  Shall  elect  from  among  its  members,  a  president 
ctnd  one  or  more  vice-presidents.  It  shall  appoint  a 
superintendent  of  the  hospital  who  shall  be  also  the 
treasurer  and  secretary  of  the  board  and  shall  hold 
office  at  the  pleasure  of  said  board.  Said  superintendent 
shall  not  be  a  member  of  the  board  of  managers,  and 
shall  be  a  graduate  of  an  incorporated  medical  college, 
"vvith  an  experience  of  at  least  three  years  in  the  actual 
practice  of  nis  profession. 

2.  Shall  fix  the  salaries  of  the  superintendent  and  all 
other  officers  and  employees  within  the  limits  of  the 
appropriation  made  therefor  by  the  board  of  supervisors, 
and  such  salaries  shall  be  compensation  in  full  for  all 
services  rendered.  The  board  of  managers  shall  deter- 
mine the  amount  of  time  required  to  be  spent  at  the 
hospital  by  said  superintendent  in  the  discharge  of  his 
duties. 

3.  Shall  have  the  general  superintendence,  manage- 
ment and  control  of  the  said  hospital,  of  the  grounds, 
buildings  officers  and  employees  thereof;  of  the  inmates 
therein,  and  of  all  matters  relating  to  the  government, 
discipline,  contracts,  and  fiscal  concerns  thereof;  and 
make  such  rules  and  regulations  as  may  seem  to  them 
necessary  for  carrying  out  the  purposes  of  such  hospital. 

4.  Shall  maintain  an  effective  inspection  of  said  hos- 
pital, and  keep  itself  informed  of  the  affairs  and  man- 
agement thereof;  shall  meet  at  the  hospital  at  least 
once  in  every  month,  and  at  such  other  times  as  may  be 
prescribed  in  the  by-laws;  and  shall  hold  its  annual 
meeting  at  least  three  weeks  prior  to  the  meeting  of  the 
board  of  supervisors  at  which  appropriations  for  the 
ensuing  year  are  to  be  considered. 

5.  Shall  keep  in  a  book  provided  for  that  purpose,  a 
proper  record  of  its  proceedings  which  shall  be  open  at 


70  THE  PUBLIC   HEALTH   LAW 

all  times  to  the  inspection  of  its  members,  to  the  mem- 
bers of  the  board  of  supervisors  of  the  county,  and  to 
duly  authorized  representatives  of  the  state  board  of 
charities. 

6.  Shall  certify  all  bills  aiid  accounts  including  sala- 
ries and  wages  and  transmit  them  to  the  board  of  super- 
visors of  the  county,  who  shall  provide  for  their  pay- 
ment in  the  same  manner  as  other  charges  against  the 
county  are  paid. 

7.  Shall  make  to  the  board  of  supervisors  of  the 
county  annually,  at  such  time  as  said  supervisors  shall 
direct,  a  detailed  report  of  the  operations  of  the  hospital 
during  the  year,  the  number  of  patients  received,  the 
methods  and  results  of  their  treatment,  together  with 
suitable  recommendations  and  such  other  matter  as  may 
be  required  of  them,  and  full  and  detailed  estimates  of 
the  appropriations  required  during  the  ensuing  year  for 
all  purposes  including  maintenance,  the  erection  of 
buildings,  repairs,  renewals,  extensions,  improvement.-?, 
betterments  or  other  necessary  purposes. 

§  48.  General  powers  and  duties  of  superintendent. — 

The  superintendent  shall  be  the  chief  executive  ofl&cer  of 
the  hospital  and  subject  to  the  by-laws,  rules  and  regu- 
lations thereof,  and  to  the  powers  of  the  board  of 
managers : 

1.  Shall  equip  the  hospital  with  all  necessary  fur- 
niture, appliances,  fixtures  and  other  needed  facilities 
for  the  care  and  treatment  of  patients  and  for  the  use 
of  officers  and  employees  thereof,  and  shall  in  counties 
where  there  is  no  purchasing  agent  purchase  all  neces- 
sary supplies. 

2.  Shall  have  general  supervision  and  control  of  the 
records,  accounts,  and  buildings  of  the  hospital  and  all 
internal  afi"airs,  and  maintain  discipline  therein,  and 
enforce  compliance  with,  and  obedience  to  all  rules,  by- 


COUXTY   TITBEECUIOSIS    HOSPITALS  71 

laws  and  regulations  adopted  by  the  board  of  managers 
for  the  government,  discipline  and  management  of  said 
hospital,  and  the  employees  and  inmates  thereof.  He 
shall  make  such  further  rules,  regulations  and  orders  as 
he  may  deem  necessary,  not  inconsistent  with  law,  or 
with  the  rules,  regulations  and  directions  of  the  board 
of  managers. 

3.  Shall  appoint  such  resident  oflB.cers  and  such  em- 
ployees as  he  may  think  proper  and  necessary  for  the 
efficient  performance  of  the  business  of  the  hospital,  and 
prescribe  their  duties;  and  for  cause  stated  in  writing, 
after  an  opportunity  to  be  heard,  discharge  any  such 
officer  or  employee  at  his  discretion. 

4.  Shall  cause  proper  accounts  and  records  of  the 
business  and  operations  of  the  hospital  to  be  kept  regu- 
larly from  day  to  day,  in  books  and  on  records  provided 
for  that  purpose;  and  see  that  such  accounts  and  rec- 
ords are  correctly  made  up  for  the  annual  report  to  the 
board  of  supervisors,  as  required  by  subdivision  seven 
of  section  forty-seven  of  this  chapter,  and  present  the 
same  to  the  board  of  managers,  who  shall  incorporate 
them  in  their  report  to  the  said  supervisors. 

5.  Shall  receive  into  the  hospital,  under  the  general 
direction  of  the  board  of  managers,  in  the  order  of  ap- 
plication, any  person  found  to  be  suffering  from  tuber- 
culosis in  any  form  who  has  been  an  actual  resident  and 
inhabitant  of  the  county  for  a  period  of  at  least  one 
year  prior  to  his  application  for  admission  to  said  hos- 
pital; and  shall  also  receive  persons  from  other  counties 
as  hereinafter  provided.  Said  superintendent  shall 
cause  to  be  kept  proper  accounts  and  records  of  the  ad- 
mission of  all  patients,  their  name,  age,  sex,  color, 
marital  condition,  residence,  occupation  and  place  of 
last  employment. 

6.  Shall  cause  a  careful  examination  to  be  made  of 
the  physical   condition  of  all  persons  admitted  to  the 


72  THE   PUBLIC    HEALTH   LAW 

hospital  and  provide  for  the  treatment  of  each  such 
patient  according  to  his  need;  and  shall  cause  a  record 
to  be  kept  of  the  condition  of  each  patient  when  ad- 
mitted, and  from  time  to  time  thereafter. 

7.  Shall  discharge  from  said  hospital  any  patient  who 
shall  wilfully  or  habitually  violate  the  rules  thereof;] 
or  who  is  found  not  to  have  tuberculosis;  or  who  is! 
found  to  have  recovered  therefrom;  or  who  for  any  other 
reason  is  no  longer  a  suitable  patient  for  treatment 
therein ;  and  shall  make  a  full  report  thereof  at  the  next 
meeting  of  the  board  of  managers. 

8.  Shall  collect  and  receive  all  moneys  due  the  hos- 
pital, keep  an  accurate  account  of  the  same,  report  the 
same  at  the  monthly  meeting  o^  the  board  of  managers, 
and  transmit  the  same  to  the  treasurer  of  the  county 
within  ten  days  after  such  meeting. 

9.  Shall  before  entering  upon  the  discharge  of  his 
duties,  give  a  bond  in  such  sum  as  the  board  of  mana- 
gers may  determine,  to  secure  the  faithful  performance 
of  such  duties. 

§  49.  Admission  of  patients  from  county  in  which 
hospital  is  situated.— Any  resident  of  the  county  in 
which  the  hospital  is  situated  desiring  treatment  in 
such  hospital,  may  apply  in  person  to  the  superintend- 
ent or  to  any  reputable  physician  for  examination,  and 
such  physician,  if  he  find  that  said  person  is  suffering 
from  tuberculosis  in  any  form,  may  apply  to  the  super''- 
intendent  of  the  hospital  for  his  adm'ission.  Blank 
forms  for  such  applications  shall  be  provided  by  the 
hospital,  and  shall  be  forwarded  by  the  superintendent 
thereof  gratuitously  to  any  reputable  physician  in  the 
county,  upon  request.  So  far  as  practicable,  applica- 
tions for  admission  to  the  hospital  shall  be  made  upon 
such  forms.  The  superintendent  of  the  hospital,  upon 
the  receipt  of  such  application,  if  it  appears  therefrom 


COUNTY  TUBEECUiOSIS   HOSPITAlS  73 

that  the  patient  is  suffering  from  tuberculosis,  and  '.f 
there  be  a  vacancy  in  the  said  hospital,  shall  notify  the 
person  named  in  such  application  to  appear  in  person 
at  the  hospital.  If,  upon  personal  examination  of  such 
patient,  or  of  any  patient  applying  in  person  for  admis- 
sion, the  superintendent  is  satisfied  that  such  person 
is  suffering  from  tuberculosis,  he  shall  admit  him  to 
the  hospital  as  a  patient.  All  such  applications  shall 
state  whether,  in  the  judgment  of  the  physician,  the 
person  is  able  to  pay  in  whole  or  in  part  for  his  care 
and  treatment  while  at  the  hospital;  and  every  applica- 
tion shall  be  filed  and  recorded  in  a  book  kept  for  that 
purpose  in  the  order  of  their  receipt.  ^Mien  said  hos- 
pital is  completed  and  ready  for  the  treatment  of 
patients,  or  whenever  thereafter  there  are  vacancies 
therein,  admissions  to  said  hospital  shall  be  made  in 
the  order  in  which  the  names  of  applicants  shall  appear 
upon  the  application  book  to  be  kept  as  above  provided, 
in  so  far  as  such  applicants  are  certified  to  by  the 
superintendent  to  be  suffering  from  tuberculosis.  Xo 
discrimination  shall  be  made  in  the  accommodation, 
care  or  treatment  of  any  patient  because  of  the  fact 
that  the  patient  or  his  relatives  contribute  to  the  cost 
of  his  maintenance  in  whole  or  in  part,  and  no  patient 
shall  be  permitted  to  pay  for  his  maintenance  in  such 
hospital  a  greater  sum  than  the  average  per  capita  cost 
of  maintenance  therein,  including  a  reasonable  allow- 
ance for  the  interest  on  the  cost  of  the  hospital;  and  no 
officer  or  employee  of  such  hospital  shall  accept  from 
any  patient  thereof  any  fee,  payment  or  gratuity  what- 
soever for  his  services. 

§  49-a.  Maintenance  of  patients  in  the  county  in 
which  hospital  is  situated.— Wherever  a  patient  has 
been  admitted  to  said  hospital  from  the  county  in  which 
the  hospital  is  situated,  the  superintendent  shall  cause 


74  THE  PUBLIC   HEALTH   LAW 

such  inquiry  to  be  made  as  he  may  deem  necessary,  as 
to  his  circumstances,  and  of  the  relatives  of  such  pa- 
tient legally  liable  for  his  support.  If  he  find  that  such 
patient,  or  said  relatives  are  able  to  pay  for  his  care 
and  treatment  in  whole  or  in  part,  an  order  shall  be 
made  directing  such  patient,  or  said  relatives  to  pay 
to  the  treasurer  of  such  hospital  for  the  support  of  such 
patient  a  specified  sum  per  week,  in  proportion  to  their 
financial  ability,  but  such  sum  shall  not  exceed  the 
actual  per  capita  cost  of  maintenance.  The  superintend- 
ent shall  have  the  same  power  and  authority  to  collect 
such  sum  from  the  estate  of  the  patient,  or  his  rela- 
tives legally  liable  for  his  support,  as  is  possessed  by 
an  overseer  of  the  poor  in  like  circumstances.  If  the 
superintendent  find  that  such  patient,  or  said  relatives 
are  not  able  to  pay,  either  in  whole  or  in  part,  for  his 
care  and  treatment  in  such  hospital,  the  same  shall 
become  a  charge  upon  the  county. 

§  49-b.  Admission  of  patients  from  counties  not  hav- 
ing a  hospital. —  In  any  county  not  having  a  county 
hospital  for  the  care  and  treatment  of  persons  suffering 
from  tuberculosis,  a  county  superintendent  of  the  poor, 
upon  the  receipt  of  the  application  and  certificate  here- 
inafter provided  for,  may  apply  to  the  superintendent 
of  any  such  hospital  established  by  any  other  county, 
for  the  admission  of  such  patient.  Any  person  residing 
in  a  county  in  which  there  is  no  such  hospital,  who 
desires  to  receive  treatment  in  such  a  hospital,  may 
apply  therefor  in  writing  to  the  superintendent  of  the 
poor  of  the  county  in  which  he  resides  on  a  blank  to 
be  provided  by  said  superintendent  for  that  purpose, 
submitting  with  such  application  a  written  certificate 
signed  by  a  reputable  physician  on  a  blank  to  be  pro- 
vided by  the  superintendent  of  the  poor  for  such  pur- 
pose,  stating  that   such   physician  has,   within  the  ten 


COUNTY  TUBERCnOSIS   HOSPITAXS  75 

days  then  next  preceding,  examined  sncli  person,  and 
that,  in  his  judgment,  such  person  is  suffering  from 
tuberculosis.  The  superintendent  of  the  poor,  on  re- 
ceipt of  such  application  and  certificate,  shall  forward 
the  same  to  the  superintendent  of  any  hospital  for  the 
care  and  treatment  of*  tuberculosis.  If  such  patient  be 
accepted  by  such  hospital,  the  superintendent  of  the  poor 
shall  proA'ide  for  his  transportation  thereto,  and  for  his 
maintenance  therein  at  a  rate  to  be  fixed  as  hereinafter 
provided. 

§  49-c.  Maintenance  of  patients  from  counties  not  hav- 
ing a  hospital. —  Whenever  the  superintendent  of  such 
a  county  hospital,  shall  receive  from  a  superintendent 
of  the  poor  of  any  other  county  an  application  for  the 
admission  of  a  patient,  if  it  appear  from  such  applica- 
tion that  the  person  therein  referred  to  is  suffering 
from  tuberculosis,  the  superintendent  shall  notify  said 
person  to  appear  in  person  at  the  hospital,  provided 
there  be  a  vacancy  in  such  hospital  and  there  be  no 
pending  application  from  a  patient  residing  in  the 
county  in  which  the  hospital  is  located.  If,  upon 
personal  examination  of  the  patient,  the  superintendent 
is  satisfied  that  such  patient  is  suffering  from  tubercu- 
losis, he  shall  admit  him  to  the  hospital.  Every  patient 
so  admitted  shall  be  a  charge  against  the  county  send- 
ing such  patient,  at  a  rate  to  be  fixed  by  the  board  of 
managers,  which  shall  not  exceed  the  per  capita  cost 
of  maintenance  therein,  including  a  reasonable  allowance 
for  interest  on  the  costs  of  the  hospital;  and  the  bill 
therefor  shall,  when  verified  by  the  superintendent  of 
the  poor  of  the  county  from  which  said  patient  was  sent, 
be  audited  and  paid  by  the  board  of  supervisors  of  the 
said  county.  The  said  superintendent  of  the  poor  shall 
cause  an  investigation  to  be  made  into  the  circum- 
stances of  such  patient,  and.  of  his  relatives  legally  liable 


76  THE  PUBLIC   HEALTH   LAW 

for  his  support,  and  shall  have  the  same  authority  as 
an  overseer  of  the  poor  in  like  circumstances  to  collect 
therefrom,  in  whole  or  in  part,  according  to  their  finan- 
cial ability,  the  cost  of  the  maintenance  of  such  person 
in  said  hospital. 

§  49-d.  Visitation  and  inspection. —  The  resident  officer 
of  the  hospital  shall  admit  the  managers  into  every 
part  of  the  hospital  and  the  premises  and  give  them 
access  on  demand  to  all  books,  papers,  accounts  and 
records  pertaining  to  the  hospital  and  shall  furnish 
copies,  abstracts  and  reports  whenever  required  by  them. 
All  hospitals  established  or  maintained  under  the  pro- 
visions of  sections  forty-five  to  forty-nine-e,  inclusive, 
of  this  chapter,  shall  be  subject  to  inspection  by  any 
duly  authorized  representative  of  the  state  board  of 
charities,  of  the  state  department  of  health,  of  the 
state  charities  aid  association  and  of  the  board  of  su- 
pervisors of  the  county;  and  the  resident  officers  shall 
admit  such  representatives  into  every  part  of  the  hos- 
pital and  its  buildings,  and  give  them  access  on  demand 
to  all  records,  reports,  books,  papers  and  accounts  per- 
taining to  the  hospital. 

§  49-e.  Hospitals  at  almshouses. —  ^Vhereve^  a  hospital 
for  the  care  and  treatment  of  persons  suffering  from 
tuberculosis  exists  in  connection  with,  or  on  the  grounds 
of  a  county  almshouse,  the  board  of  supervisors  may, 
after  sections  forty-five  to  forty-nine-e  of  this  chapter 
take  effect,  appoint  a  board  of  managers  for  such  hos- 
pital and  such  hospital,  and  its  board  of  managers,  shall 
thereafter  be  subject  to  all  the  provisions  of  this  act, 
in  like  manner  as  if  it  had  been  originally  established 
hereunder.  Any  hospital  which  may  hereafter  be  estab- 
lished by  any  board  of  supervisors  shall  in  like  manner 
be  subject  to  all  the  provisions  of  said  section. 


THE  PEXAL  LAW  77 

THE  PENAL  LAW 

Crimes  Against  the  Public  Health  and  Safety 

§  1530.  Public  nuisance  defined. —  A  public  nuisance  is 
a  crime  against  the  order  and  economy  of  the  state,  and 
consists  in  unlawfully  doing  an  act,  or  omitting  to  per- 
form a  duty,  which  act  or  omission: 

1.  Annoys,  injures,  or  endangers  the  comfort,  repose, 
health  or  safety  of  any  considerable  number  of  per- 
sons; or 

2.  Offends   public   decency;   or 

3.  Unlawfully  interferes  with,  obstructs,  or  tends  to 
obstruct,  or  renders  dangerous  for  passage,  a  lake,  or  a 
navigable  river,  bay,  stream,  canal  or  basin,  or  a 
stream,  creek,  or  other  body  of  water  which  has  been 
dredged  or  cleared  at  public  expense,  or  a  public  park, 
square,  street  or  highway;   or 

4.  In  any  way  renders  a  considerable  number  of  per- 
sons insecure  in  liie,  or  the  use  of  property. 

§  1531.  Unequal  damage. —  An  act  which  affects  a  con- 
siderable number  of  persons,  in  either  of  the  ways 
specified  in  the  last  section,  is  not  less  a  nuisance  be- 
cause the  extent  of  the  damage  is  unequal. 

§  1532,  Maintaining  a  nuisance. —  A  person,  who  com- 
mits or  maintains  a  public  nuisance,  the  punishment 
for  which  is  not  specially  prescribed,  or  who  wilfully 
omits  or  refuses  to  perform  any  legal  duty  relating  to 
jthe  removal  of  such  a  public  nuisance,  is  guilty  of  a 
misdemeanor. 

§  1740.   Wilful  violation  of  health  laws.— 
1.  A  person  who  wilfully  violates  or  refuses  or  omits 
to    comply   with    any    lawful    order    or    regulation    pre- 


78  THE  PUBLIC  HEALTH  LAW 

scribed   by    any   local   board  of   health  or   local   health 
officer,  is  guilty  of   a   misdemeanor. 

2.  A  person  who  wilfully  violates  any  provision  of 
the  health  laws,  or  any  regulation  lawfully  made  or 
established  by  any  public  officer  or  board  under  au- 
thority of  the  health  laws  the  punishment  for  violating 
which  is  not  otherwise  prescribed  by  those  laws,  or 
by  this  code,  is  punishable  by  imprisonment  not  exceed- 
ing one  year,  or  by  a  fine  not  exceeding  two  thousand 
dollars  or  by  both. 

§  1741.  Obstructing  health  officer  in  performance  of 
his  duty. —  A  person  who  wilfully  opposes  or  obstructs 
a  health  ofiicer  or  physician  charged  with  the  enforce- 
ment of  the  health  laws,  in  performing  any  legal  duty  is 
guilty  of  a  misdemeanor. 

§  1750.  Disposing  of  tainted  food.— A  person  who 
with  intent  that  the  same  may  be  used  as  food,  drink,  or 
medicine,  sells,  or  offers  or  exposes  for  sale,  any  article 
whatever  which,  to  his  knowledge,  is  tainted  or  spoiled, 
or  for  any  cause  unfit  to  be  used  as  such  food,  drink,  or 
medicine,  is  guilty  of  a  misdemeanor. 

§  1753.  Articles  in  imitation  of  food. —  A  person  who 
sells  or  manufactures,  exposes  or  offers  for  sale  as  an 
article  of  food,  any  substance  in  imitation  thereof,  with- 
out disclosing  tne  imitation  by  a  suitable  and  plainly 
visible  mark  or  brand,  is  gmilty  of  a  misdemeanor. 

§  1756.  Exposing  person  affected  with  a  contagious 
disease  in  a  public  place. —  A  person,  who  wilfully  ex- 
poses himself  or  another,  affected  with  any  contagious 
or  infectious  disease,  in  any  public  place  or  thorough- 
fare, except  upon  his  necessary  removal  in  a,  manner 
not  dangerous  to  the  public  health,  is  guilty  of  a  mis- 
demeanor. 


VILLAGE  LAW  79 

VILLAGE  LAW 

ARTICLE    II 

Sewers 

Section  260.  Establishment  of  sewer  system, 

261.  Construction  of  sewer  at  expense  of  village. 

262.  Eeimbursement   for    sewers    constructed    at 

private  expense. 

263.  Construction  of   sewer  at  joint   expense  of 

village  and  of  property  benefited. 

264.  Construction   of    sewers  wholly   at  expense 

of   property  benefited. 

265.  Acquisition   of   property   by    condemnation. 

266.  Contracts  for  construction  of  system. 

267.  Supervising  engineer;   inspectors. 

268.  Apportionment  of  local   assessment. 
269".  Appeal  from  apportionment. 

270.  Hearing  of  appeal. 

271.  Eeapportionment. 

272.  Procedure  by  new  commissioners. 

273.  Fees  of  commissioners. 

274.  Expense  of  construction;  how  raised. 

275.  Tax  for  unpaid  assessments. 

276.  Contracts  with  other  municipalities. 

277.  Annual  report  of  sewer  commissioners. 

§  260.   Establishment  of  sewer  system. —  The  board  of 

sewer  commissioners  of  a  village  may  establish,  extend 
and  maintain  a  sewer  system  therein.  Before  taking 
any  proceedings  for  the  construction  of  any  sewer,  the 
board,  at  the  expense  of  the  village,  shall,  unless  such 
map  and  plan  have  already  been  officially  approved 
by  the  state  commissioner  of  health  and  copies  filed 
in  the-  state  department  of  health  and  in  the  office  of 
the  village  clerk,  cause  a  map  and  plan  of  a  permanent 
sewer  system  for  such  village  to  be  made,  with  specifi- 


so  THE    PUBLIC    IIE-VLTH    LAW  "     '" 

cations  of  dimensions.,  connections  and  outlets  of  sewage 
disposal  works.  It  may  also  include  any  existing  sewer 
in  the  village,  which  on  examination  by  the  village 
engineer  shall  be  found  feasible  and  proper  to  incor- 
porate or  include  in  the  proposed  system.  Such  map 
and  plan  shall  be  comprehensive  and  shall  cover  all 
portions  of  the  village;  but  the  village  may  construct 
the  whole  of  the  said  system  or  may  t-emporarily  omit 
any  portions  thereof  until  such  portions  may  be  neces- 
sary, subject  to  the  approval  of  such  omission  by  the 
state  commissioner  of  health  as  hereinafter  provided. 
Such  map  and  plan  shall  be  submitted  to  the  state 
commissioner  of  health  for  his  approval,  and  if  approved 
shall  be  filed  in  his  ofiice.  A  copy  thereof  shall  also  be 
tiled  in  the  ofnc-«  of  the  village  clerk.  The  map  an(^ 
plan  may  be  amended,  with  the  approval  cf  the  state 
commissioner  of  health,  and  when  so  amended  and  ap- 
proved shall  be  filed  in  the  same  offices  as  the  original. 
Xo  work  of  any  kind  shall  be  done  on  or  for  the  con- 
struction, extension,  reconstruction,  removal  or  modifica- 
tion of  any  system  of  sewers  or  of  any  sewer  thereof 
until  a  map  and  plan  covering  the  entire  system  shall 
first  have  been  duly  approved  and  filed  as  above  pro- 
vided, and  in  the  execution  of  the  construction,  exten- 
sion, reconstruction,  removal  or  modification  of  any  sys- 
tem of  sewers  or  of  any  sewer  thereof  no  deviations 
from  the  plans  as  finally  approved  and  filed  shall  be 
made  until  plans  or  descriptions  adequately  showing' 
such  deviations  are  first  approved  and  filed  as  above 
provided.  Whenever  the  board  of  sewer  commissioners 
of  the  village  shall  deem  it  desirable  to  the  interests  of 
the  village  that  a  portion  of  the  permanent  general 
system  of  sewers  and  sewage  disposal  thereof  may  be 
temporarily  omitted  or  deferred,  it  shall  certify  that 
fact  in  writing  to  the  state  commissioner  of  health, 
designating  by  a  map  or  otherwise  the  portions  of  the 


vnXAGE   SEWEE   SYSTEM  81 

system  to  be  omitted,  or  the  portion  not  to  be  omitted, 
and  on  receipt  of  the  same  the  state  commissioner  of 
health  may  approve  of  such  temporary  omission  and 
shall  certify  his  determination  to  the  board  of  sewer 
commissioners  of  the  village. 

§  261.  Construction  of  a  sewer  at  expense  of  village. — 

Upon  the  adoption  of  a  proposition  therefor  the  whole 
or  any  part  of  the  sewer  system  may  be  constructed 
at  the  expense  of  the  village.  The  proposition  shall 
describe  the  portion  of  the  system  proposed  to  be  so  con- 
structed, and  shall  also  contain  a  statement  of  the 
estimated  maximum  and  minimum  cost  thereof. 

§  262.  Reimbursement  for  sewers  constructed  at  pri- 
vate expense. —  If  the  whole  of  the  sewer  system  be 
constructed  at  the  expense  of  the  village  and  a  sewer 
theretofore  constructed  wholly  or  partly  at  private 
expense  be  included  in  the  map  or  plan  of  the  system, 
the  owners  of  the  property  upon  which  such  expense 
was  assessed  shall  be  entitled  to  reimbursement  there- 
for. Claims  for  such  reimbursement  may  be  presented 
to  and  audited  by  the  board  of  sewer  commissioners, 
and  the  amounts  allowed  shall  be  paid  in  the  same 
manner   as  other  expenditures  for  the   sewer  system. 

§  263.  Construction  of  sewer  at  joint  expense  of  vil- 
lage and  of  property  benefited- — ^Upon  the  adoption  or  a 
proposition  therefor,  the  whole  or  any  part  of  the  sewer 
system  may  be  constructed  at  the  joint  expense  of  the 
village  and  of  the  property  benefited.  The  proposition 
shall  describe  the  portion  of  the  system  proposed  to 
be  so  constructed,  shall  contain  a  statement  of  the 
estimated  maximum  and  minimum  cost  thereof,  and 
also  of  the  proportion  of  the  expense  to  be  assessed  upon 

6 


82  THE  PUBLIC   HEALTH  LAW 

the  village  at  large,  and  the  aggregate  proportion  to 
be  assessed  upon  the  property  benefited.  If  the  proposi- 
tion be  adopted  such  aggregate  proportion  shall  be 
equitably  adjusted  with  reference  to  the  benefits  to  be 
derived  therefrom. 

§  264.  Construction  of  sewers  wholly  at  expense  of 
property  benefited. —  The  owners  of  two-thirds  of  the 
entire  frontage  of  the  portion  of  a  street  or  streets 
in   which   a  sewer   is  proposed   to  be  constructed  may 

present  to  the  board  of  sewer  commissioners  a  peti- 
tion for  the  construction  of  such  a  sewer.  The  board 
shall  cause  a  notice  of  at  least  ten  days  to  be  given 
to  each  person  owning  land  fronting  on  such  portion 
of  such  street  or  streets,  of  a  time  and  place  where 
it  will  meet  and  hear  persons  interested  in  the  con- 
struction of  such  sewer.  After  such  hearing  the  board 
may  grant  the  petition  in  whole  or  in  part,  and  shall 
construct  a  sewer  as  ordered,  and  assess  the  entire  ex- 
pense thereof  upon  the  property  benefited.  Where 
such  petition  is  for  the  construction  of  a  sewer  through 
different  streets,  such  sewer  shall  be  deemed  one  sewer, 
and  such  streets,  one  continuous  street,  for  the  purposes 
of  this  section.  A  petition  under  this  section  may 
limit  the  maximum  amount  of  the  expense  to  be  in- 
curred in  the  construction  of  such  sewer. 

§  265.   Acquisition  of  property  by  condemnation. —  If 

the  board  of  sewer  commissioners  is  unable  to  agree 
with  the  owner  for  the  purchase  of  real  property  neces- 
sary for  the  sewer  system,  it  may  acquire  the  same  by 
condemnation. 

§  266.    Contracts    for   construction    of    system. —  The 

board  of  sewer  commissioners  of  a  village  authorized 
to  construct  the  whole  or  any  part  of  a  sewer  system 


VrLLAGE  SEWER   SYSTEM  83 

shall  advertise  for  proposals  for  the  construction 
thereof,  either  under  an  entire  contract,  or  in  parts 
or  sections,  as  the  board  may  determine.  Such  ad- 
vertisement shall  be  published  once  in  each  of  two 
successive  weeks  in  each  newspaper  published  in  the 
village.  The  board  may  require  a  bond  or  a  deposit 
from  the  person  submitting  a  proposal,  the  liability 
of  such  bond  to  accrue,  or  such  deposit  to  be  for- 
feited to  the  village,  in  case  such  person  shall  refuse 
to  enter  into  a  contract  in  accordance  with  his  pro- 
posal. The  board  may  accept  or  reject  any  proposal, 
may  contract  with  other  than  the  lowest  bidder,  or 
may  reject  all  proposals  and  advertise  again.  No 
contract  shall  be  made  by  which  a  greater  amount 
shall  be  agreed  to  be  paid,  than  the  maximum  stated 
in  the  proposition  or  in  the  petition  for  the  construction 
of  such  sewer. 

§   267.  Supervising  engineer;    inspectors. —  The  board 

of  sewer  commissioners  may  employ  a  supervising  en- 
gineer to  superintend  and  inspect  the  construction  of 
any  sewer  or  works  connected  therewith,  and  also  such 
inspectors  as  may  be  necessary,  and  fix  the  compensation 
of  such  engineer  and  inspectors.  Such  compensation 
shall  be  treated  as  a  part  of  the  expense  of  construction. 

§  268.  Apportionment  of  local  assessment. —  If  the 
whole  or  any  part  of  the  expense  of  constructing  a 
sewer  is  to  be  assessed  upon  the  lands  benefited  the 
board  of  sewer  commissioners  shall  prepare  and  file 
in  the  office  of  the  village  clerk,  a  map  and  plan  of 
the  proposed  area  of  local  assessment.  Such  expense 
shall  thereupon  be  apportioned  upon  the  lands  within 
such  area  in  proportion  as  nearly  as  may  be  to  the 
benefit  which  each  lot  or  parcel  will  derive  there- 
from,   and    the    ratio    of    such    benefit   shall   be    estab- 


84  THE  PUBLIC   HEALTH    LAW 

lished.  After  making  such  apportionment  the  board 
shall  serve  upon  each  land  owner  a  notice  thereof 
and  of  the  filing  of  such  map  and  plan,  and  that  at 
a  specified  time  and  place  a  hearing  will  be  had  to 
consider  and  review  the  same.  Such  notice  must  be 
served  at  least  six  days  before  the  hearing.  The 
board  shall  meet  at  the  time  and  place  specified  and 
hear  objections  to  such  apportionment.  It  may  mod- 
ify and  correct  the  same  or  exclude  land  from  the 
area  of  local  assessment.  The  board  of  sewer  com- 
missioners, upon  the  completion  of  such  apportion- 
ment, shall  file  the  same  in  the  office  of  the  village 
clerk.  The  apportionment  shall  be  deemed  final  and 
conclusive,  unless  an  appeal  be  taken  therefrom  within 
fifteen  days  after  the  filing  thereof. 

§  269.  Appeal  from  apportionment. —  A  person  ag- 
grieved by  an  apportionment  may,  within  fifteen  days 
after  the  filing  thereof,  appeal  therefrom  to  the  county 
court  of  a  county  in  which  any  part  of  the  village  is 
situated.  Such  appeal  shall  be  taken  by  a  notice, 
stating  the  grounds  thereof,  addressed  to  the  board  of 
sewer  commissioners,  and  filed  with  the  village  clerk. 

§  270.  Hearing  of  appeal. —  Either  party  may  bring 
on  the  appeal  upon  a  notice  of  not  less  than  ten  nor 
more  than  twenty  days.  All  appeals  from  the  same 
apportionment  must  be  consolidated  and  heard  as  one 
appeal.  The  county  court  may  affirm  or  reverse  the 
apportionment.  If  it  be  reversed  upon  the  ground  that 
it  is  erroneous,  unequal  or  inequitable,  the  court  shall 
by  the  order  of  reversal  appoint  three  disinterested 
freeholders  of  the  village  as  commissioners  to  make  a 
new  apportionment,  and  no  appeal  shall  be  allowed 
from  such  order. 


VTLXAGE    SEWER   SYSTEM  85 

§  271.  Reapportionment. — A  reapportionment  shall  be 
made  in  the  following  cases: 

1,  By  the  commissioners  appointed  by  the  county 
court,  where  the  original  apportionment  is  reversed 
on  the  ground  that  it  is  erroneous,  unequal  or  in- 
equitable. 

2.  By  the  board  of  sewer  commissioners  where  the 
original  apportionment  is  reversed  upon  any  other 
ground.  A  reapportionment  under  this  subdivision  shall 
be  made  in  like  manner  as  the  original. 

§  272.  Procedure  by  new  commissioners. —  The  com- 
missioners appointed  by  the  county  court  shall  give 
notice  of  the  time  and  place  at  which  they  will  meet 
to  make  such  reapportionment,  and  shall  serve  notice 
thereof  at  least  ten  days  before  such  meeting  upon 
each  owner  of  land  within  the  area  of  local  assess- 
ment as  finally  fixed  by  the  board  of  sewer  com- 
missioners. They  shall  meet  at  the  time  and  place 
specified  and  make  such  reapportionment  in  the  man- 
ner herein  prescribed  for  the  board  of  sewer  commis- 
sioners. They  shall  file  such  reapportionment  in  the 
office  of  the  village  clerk,  and  it  shall  be  final  and 
conclusive. 

§  273  Fees  of  commissioners. —  Each  commissioner  ap- 
pointed by  the  county  court  is  entitled  to  five  dol- 
lars for  each  day  necessarily  spent  in  making  sucH 
reapportionment,  besides  his  actual  necessary  expenses. 
Such  fees  and  expenses  are  a  charge  against  the  vil- 
lage, and  must  be  audited  by  the  board  of  trustees. 
The  amount  thereof  shall  be  added  to  the  portion  of 
the  expense  of  constructing  such  sewer  or  sewer  system 
which  is  to  be  assessed  against  property  specially 
benefited. 


86  THE   PUBLIC    HEALTH    LAW 

§  274.  Expense  of  construction;  how  raised. —  The  ex- 
pense of  constructing  a  sewer  or  a  sewer  system  may 
be  raised  in  an  entire  amount  or  in  smaller  sums  from 
time  to  time  as  the  board  of  sewer  commissioners  may 
determine.  If  any  portion  of  such  expense  is  to  be 
borne  by  the  village,  bonds  or  certificates  of  indebted- 
ness may  be  issued  therefor.  If  such  expense  or  any  part 
thereof  is  to  be  assessed  upon  property  benefited,  the 
board  may  assess  the  same,  or  the  instalment  to  be 
raised,  on  the  several  benefited  lots  or  parcels,  in  ac- 
cordance with  the  apportionment  and  ratio  established 
under  this  article.  Xotice  of  such  assessment  shall  be 
given  to  the  owners,  who  may  pay  the  amounts  assessed 
within  ten  days  after  the  service  of  such  notice.  At 
the  expiration  of  such  time  bonds  or  certificates  of  in- 
debtedness may  be  issued  for  the  aggregate  amount  of 
such  assessment  then  remaining  unpaid. 

§  275.  Tax  for  unpaid  assessments. —  The  board  of 
trustees  shall  include  in  the  annual  tax  levy  the  prin- 
cipal or  interest  accruing  during  the  same  fiscal  year 
upon  bonds  or  certificates  of  indebtedness  issued  on 
account  of  default  in  the  payment  of  local  assessments 
under  this  article,  and  shall  levy  the  same  upon  the 
lots  or  parcels  in  default. 

Such  principal  shall  be  apportioned  among  the  lots 
or  parcels  in  default  so  that  the  tax  thereon  will  be 
the  same  as  if  an  equal  portion  of  the  assessment 
were  then  to  be  paid.  Interest  on  an  unpaid  assess- 
ment shall  be  added  to  such  tax  at  the  rate  payable 
by  the  bond  or  certificate  of  indebtedness,  which  must 
be  computed  to  the  time  when  the  principal  or  an  in- 
stalment will  become  due;  or  if  no  principal  will  become 
due  during  the  fiscal  year,  then  the  interest  accruing 
during  that  year  upon  the  assessment  must  be  levied 
upon  such  lot  or  parcel. 


VIILAGE   SEWEB  SYSTEM  87 

§  276.  Contracts  with  other  municipalities. —  The 
board  of  sewer  commissioners  may  contract  for  the  con- 
nection of  the  sewers  thereof  with  the  sewers  of  another 
village,  or  of  a  town  or  city;  or  jointly  with  such  other 
village  or  a  town  or  city  may  construct,  maintain, 
operat-e  or  use  sewers,  outlets  or  disposal  works;  or  may 
contract  with  any  such  other  village,  or  a  town  or  city, 
for  the  right  to  construct  and  maintain  through  any 
such  other  village,  town  or  city  an  outlet  sewer,  includ- 
ing the  right  to  acquire  real  property  for  such  sewer 
outlet,  which  thereupon  may  be  acquired  either  at  pri- 
vate sale  or  by  condemnation  as  authorized  by  this  act. 
But  no  such  contract  shall  be  made  unless  a  proposition 
therefor  be  adopted,  stating  the  maximum  expense. 

§  277.  Annual  report  of  sewer  commissioners. —  Be- 
tween the  first  and  fourth  day  of  March  in  each  year, 
the  board  of  sewer  commissioners  shall  file  with  the 
village  clerk  a  report  containing  a  statement  of  the 
following  facts: 

1.  The  amount  of  money  on  hand  at  the  beginning 
of  the  preceding  fiscal  year,  and  the  receipts  from  all 
sources  during  such  year. 

2.  An  itemized  statement  of  the  amount  paid  out 
during  such  year,  and  the  balance  on  hand. 

3.  The  outstanding  indebtedness  of  the  department, 
either  bonded  or  otherwise,  separately  stated. 

4.  A  statement  of  the  principal  or  interest  which 
will  become  due  during  the  current  fiscal  year  on  bonds 
or  certificates  of  indebtedness. 

5.  The  improvements  and  extensions  made  during  such 
preceding  year,  and  the  general  condition  of  the  sewer 
system. 

6.  Such  other  facts  as  the  board  deems  important 
for  the  information  of  the  village,  together  with  such 
recommendations  concerning  the  department  as  may  ba 
deemed  proper. 


88  THE  PUBLIC  HEALTH   LAW  j 

TOWN  LAW 

ARTICLE    II 

Sewers 

Section  230.  Town   board   may   establish   sewer   system; 
petition. 

231.  Action  by  town  board. 

232.  Oaths  and  undertakings  of   commissioneis. 

233.  Approval    and   filing   of   map   and   plan   of 

sewer  system. 

234.  Contracts    for    the    construction    of    sewer 

system. 

235.  Supervising    engineer,    inspectors    and    at- 

torney. 

236.  Acquisition  of  property  by  condemnation. 

237.  Apportionment  of  local  assessment. 

238.  Appeal  from  apportionment. 

239.  Hearing  of  appeal. 

240.  Reapportionment. 

241.  Procedure  by  new  commissioners. 

242.  Fees  of  commissioners. 

243.  Expense  of  construction,  how  raised;  issue 

of  town  bonds. 

244.  Tax  for  payment  of  bonds.    . 

§  230.  Town  board  may  establish  sewer  system;  peti- 
tion.—  The  town  board  of  "any  town  on  the  petition  of 
a  majority  of  the  owners  of  real  property  in  a  proposed 
district,  or  in  a  proposed  extension  of  an  existing  dis- 
trict, representing  a  majority  of  the  taxable  property 
therein,  as  appears  by  the  last  preceding  completed  as- 
sessment-roll, may  establish  a  sewer  system  outside  an 
incorporated  village  or  city,  or  extend  the  boundaries 
of  an  existing  district  and  the  sewer  system  therein  ac- 
cordingly.    The  petition  must  describe  the  proposed  dis- 


TOWX    SEWEES  89 

trict,  or  proposed  extension  of  an  existing  district,  and 
state  the  maximum  amount  proposed  to  be  expended  in 
the  construction  of  such  sewer  system  or  extension. 
Each  petitioner  shall  state  opposite  his  name  the  as- 
sessed valuation  of  the  real  property  owned  by  him  in 
such  district,  or  extension  of  an  existing  district,  accord- 
ing to  the  last  preceding  completed  assessment-roll. 
The  petition  must  be  signed  by  the  petitioners  and  ac- 
knowledged in  the  same  manner  as  a  deed  to  be  recorded, 
and  if  it  be  a  petition  to  extend  an  existing  district  and 
the  sewer  system  therein  shall,  in  addition  to  the  fore- 
going provisions,  be  approved  in  writing  by  the  sewer 
commissioners  of  such  district.  There  shall  be  annexed 
to  and  presented  with  such  petition  a  map  and  plan  of 
the  proposed  sewer  system,  or  extension,  with  specifica- 
tions of  dimensions  and  connections  and  outlet  or  sew- 
age disposal  works  prepared  by  a  competent  engineer 
at  the  expense  of  the  petitioners.  The  petitioners  may, 
however,  present  to  the  town  board  with  such  petition, 
map,  plan  and  specifications,  a  statement,  verified  by 
one  of  the  petitioners  having  personal  knowledge  of  the 
correctness  thereof,  showing  the  amount  of  the  actual 
cost  to  them  of  said  map,  plan  and  specifications  and 
the  cost  of  the  acknowledgments  of  the  signatures  to 
such  petition,  and  by  whom  paid,  which  said  amount, 
if  found  by  the  town  board  to  be  just  and  reasonable, 
and  if  the  said  town  board  shall  make  one  of  the  orders 
as  provided  by  section  two  hundred  and  thirty-one  of 
this  chapter,  shall  be  and  become  a  part  of  the  expense 
of  construction,  and  shall  be  included  in  the  first  tax 
levy  therefor,  and  shall  be  refunded  to  the  person  or 
persons  by  whom  paid  as  shown  by  the  aforesaid  state- 
ment, by  the  supervisor  of  the  town,  who  shall  take  a 
receipt  therefor.  At  any  time  after  the  town  board  has 
made  an  order  establishing  such  district,  or  extending 
an  existing  district,  the  maximum  amount  proposed  to 


90  THE   PUBLIC    HEALTH    LAW 

be  expended  in  the  construction  of  such  sewer  system 
in  said  district,  or  extension,  may  be  increased,  by  a 
petition  of  a  majority  of  the  owners  of  real  property  in 
said  district,  or  extension,  representing  a  majority  of 
the  taxable  property  therein,  as  appears  by  the  last 
preceding  completed  assessment-roll,  setting  forth  the 
additional  amount  proposed  to  be  expended,  in  excess 
of  the  maximum  amount  set  forth  in  the  petition  upon 
which  the  said  district,  or  extension,  was  established. 
Such  petition  must  be  signed  and  acknowledged  in  the 
same  manner  as  the  petition  for  the  establishment  of 
said  sewer  district,  or  extension,  and  shall  be  filed  in 
the  office  of  the  town  clerk.  Every  petition  made  as 
provided  in  this  section  shall  contain  a  statement  con- 
spicuously printed  thereon  as  follows:  ''The  cost  of 
construction  and  maintenance  of  such  sewer  system  (or 
extension,  as  the  case  may  be)  shall  be  assessed,  from 
year  to  year,  by  the  sewer  commissioners  to  be  ap- 
pointed, upon  the  lands  within  the  sewer  district  or  ex- 
tension in  proportion  as  nearly  as  may  be  to  the  benefit 
which  each  lot  or  parcel  will  derive  therefrom." 

§  2,  Section  two  hundred  and  thirty-one  of  said  chap- 
ter is  hereby  amended  to  read  as  follows: 

§  231.  Action  by  town  board.  If  the  town  board  is 
satisfied  that  the  petitioners  are  a  majority  of  the 
owners  of  real  property  in  the  proposed  district,  or  ex- 
tension, and  owns  a  majority  in  value  of  the  taxable 
property  therein,  they  shall  make  an  order  establishing 
such  district,  or  extending  the  boundaries  of  an  ex- 
existing  district,  and  if  establishing  a  new  district, 
appointing  three  taxpayers  therein  as  sewer  commis- 
sioners, who  shall  hold  their  offices  at  the  pleasure  of 
the  town  board.  Such  sewer  commissioners  shall  each 
be  paid  for  their  services,  at  such  times  as  the  town 
board  may  designate  in  said  order,  an  amount  to  be  fixed 


TOWN   SEWERS  91 

•y  the  town  board,  wliicli  amount  shall  not  exceed  three 
[ollars  per  day  for  each  day  actually  and  necessarily 
pent  in  the  business  of  the  sewer  district  and  shall  be 
teemed  an  expense  of  maintaining  the  sewer  system  and 
hall  be  collected  and  paid  as  provided  in  section  two 
lundred  and  forty-three  of  this  chapter  for  expense  of 
naintenauce. 

§  3.  Section  two  hundred  and  thirty-three  of  said 
'hapter  is  hereby  amended  to  read  as  follows: 

§  232.  Oaths  and  undertakings  of  commissioners.— 
Each  commissioner  before  entering  on  the  duties  of  his 
office  shall  take  the  constitutional  oath  of  office  and 
execute  to  the  town  and  file  with  the  town  clerk  an 
official  undertaking  in  such  sum  and  with  such  sureties 
as  the  town  board  shall  direct.  The  town  board  may 
at  any  time  require  any  such  commissioner  to  file  a 
new  official  undertaking  for  such  sum  and  with  such 
sureties  as  the  board  shall  direct. 

§  233.  Approval  and  filing  of  map  and  plan  of  sewer 
system.  The  sewer  commissioners  shall  cause  a  copy 
of  the  map  and  plan  of  the  proposed  sewer  system,  or 
proposed  extension  thereof,  to  be  submitted  to  the 
state  board  of  health,  and  if  approved,  it  shall  be  filed 
in  its  office.  Such  map  and  plan  may  be  amended  with 
the  approval  of  the  state  board  of  health,  and  if 
amended,  it  shall  be  filed  in  the  offices  of  the  state 
board  of  health  and  of  the  town  clerk. 

§  4.  Section  two  hundred  and  thirty-four  of  said 
chapter  is  hereby  amended  to  read  as  follows: 

§  234.  Contracts  for  the  construction  of  sewer  system. 
—  The  sewer  commissioners  of  such  district  shall  adver- 
tise for  proposals  for  the  construction  of  a  sewer  sys- 
tem, or  an  extension  thereof,  according  to  such  map  and 


92  THE   PUBLIC    HEALTH    LAW 


plan,  finally  filed,  cither  under  an  entire  contract  or  ii, 
parts   or   sections   as   the  board  may  determine.     Sucl; 
advertisement  shall  be  published  once  in  each  of  twc, 
successive  weeks   in   each  newspaper  published   in   sai( 
sewer   district   and  extension  thereof,  and  if  no  news) 
paper  is  published  therein,  in  the  two  newspapers  pub-; 
lished    nearest    thereto.     The    commissioners    may    re, 
quire   a   bond   or  deposit   from   each  person   submitting! 
a  proposal,  to  be  not  less  than  twenty-five  per  centum) 
of  the  amount  involved,  the  liability  on  such  bond  tc| 
accrue,  or  such  deposit  to  be  forfeited  to  the  town,  irj 
case  such  person  shall  refuse  to  enter  into  a  contract  in 
accordance  with  his  proposal.     The  commissioners  may 
accept  or  reject  any  or  all  proposals,  and  when  the  con- 
tract is  let  it  shall  be  let  to  the  lowest  bidder.     No  con- 
tract shall  be  made  by  which  a  greater  amount  shall  be 
agreed  to  be  paid  than  the  maximum  amount  stated  in' 
the   petition   for    the   construction    of   such     sewer,    as: 
amended  by  supplemental  petition,  if  any,  including  the 
expense  of  superintendence  and   inspection  as  provided) 
in  section  two  hundred  and  thirty-five.     Each  contract i 
shall  be  executed  in   duplicate,  one   of  which  shall  be: 
given  to  the  contractor  and  the  other  shall  be  filed  in; 
the  office  of  the  town  clerk.  j 

§  5.  Section  two  hundred  and  thirty-five  of  said  chap-j 
ter  is  hereby  amended  to  read  as  follows:  j 

§  235.  Supervising  engineer,  inspectors  and  attorney,  j 

—  The  sewer  commissioners  may  employ  an  attorney,  j 
a  supervising  engineer  to  superintend  and  inspect  the  j 
construction  of  any  sewer,  or  extension  thereof,  or  j 
works  connected  therewith,  and  also  such  inspectors  as 
may  be  necessary,  and  fix  the  compensation  of  such  i 
attorney,  engineer  and  inspectors.  Such  compensation,  i 
together  with  the  fees,  charges  and  expenses  of  the 
engineer  employed  to  prepare  the  map,  plan  and  speei- 


TOWN   SEWEES  93 

ations,  and  the  cost  of  the  acknowledgments  of  the 
^natures  of  the  petitioners,  as  provided  for  in  section 
'o  hundred  and  thirty  of  this  chapter,  shall  be  treated 
a  part  of  the  expense  of  construction. 
§  6.  Section  two  hundred  and  thirty-seven  of  said 
apter  is  hereby  amended  to  read  as  follovrs: 

§  236.  Acquisition  of  property  by  condemnation. —  If 

wer  commissioners  are  unable  to  agree  with  the  owners 
r  the  purchase  of  lesLl  property  necessary  for  the  con- 
ruction  of  tile  sewer  system,  they  may  acquire  the 
me  by  condemnation. 

§  237.  Apportionment  of  local  assessment  for  con- 
viction.—  Tlie  sewer  commissioners  shall  prepare  and 
I  in  the  office  of  the  town  clerk  a  map  and  plan  of 
eh  district,  or  extension,  which  shall  show  the  high- 
i,ys  and  the  several  parcels  of  land  therein.  The  com- 
ssioners  shall  report  to  the  town  board  the  amount 
the  cost  of  construction  of  such  sewer  system  as  de- 
•mined  under  the  foregoing  provisions  hereof.  The 
ivn  board  shall  direct  the  issue  and  sale  of  bonds  for 
3  amount  of  the  cost  of  construction  as  so  reported 
said  board  by  the  said  commissioners,  which  bonds 
ill  be  redeemable  in  such  equal  yearly  instalments, 
3  interest  thereon  to  be  paid  semi-annually,  as  said 
vn  board  shall  prescribe,  and  shall  be  a  town  charge. 
ithe  month  of  July  in  each  year  the  town  board  shall 
tify  the  sewer  commissioners  of  the  amount  to  be- 
ne due  for  principal  and  interest  during  the  ensuing 
ir  on  the  bonds  so  issued.  The  sewer  commissioners 
iiU  forthwith  proceed  to  assess  such  amoimt  on  the 
'ids  within  such  district,  or  extension  of  an  existing 
trict,  in  proportion  as  nearly  as  may  be  to  the  benefit 
|.ich  each  lot  or  parcel  will  derive  therefrom.  After 
l.king  such   apportionment,    said    commissioners    shall 


94  THE   PUBLIC   HEALTH    LAW 

forthwith  serve  or  cause  to  be  served  on  each  lantj 
owner  a  notice  of  the  completion  thereof  and  of  th( 
filing  of  such  map  and  plan,  and  that  at  a  specified  time 
and  place  a  hearing  will  be  had  to  consider  and  reviev 
the  same.  Such  notice  must  be  served  at  least  six  dayi 
before  the  hearing  (jjersonally)  if  such  land  owner  i; 
known  to  them  and  can  with  reasonable  diligence  b< 
found  within  the  state;  if  he  cannot  be  so  found,  h} 
mailing  same  to  his  last  known  postoffice  address,  an( 
if  the  name  or  address  of  such  owner  be  unknown,  b^ 
posting  said  notice  in  a  prominent  place  on  the  property! 
to  be  assessed.  The  commissioners  shall  meet  at  tb 
time  and  place  specified  to  hear  objections  to  such  ap 
portionment,  and  may  modify  and  correct  the  same 
The  sewer  commissioners  upon  the  complefion  and  cor 
rection  of  such  apportionment  shall  forthwith  file  thi 
same  in  the  office  of  the  town  clerk,  and  shall  giv 
notice  of  the  filing  of  such  completed  and  corrected  ap 
portionment  in  the  manner  provided  for  by  sectioi 
thirtv-niue  of  the  tax  law  as  to  towns.  The  appor 
tionment  shall  then  be  deemed  final  and  conclusive  un 
less  an  appeal  is  taken  therefrom,  as  hereinafter  pro 
vided,  within  fifteen  days  after  the  filing  thereof.  Th 
town  board  shall  present  to  the  board  of  supervisors  a 
its  annual  meeting,  a  statement  of  such  apportionmen 
as  so  corrected  and  filed,  showing  the  amount  due,  o 
to  become  due,  for  principal  and  interest  during  the  en 
suing  year,  on  the  bonds  issued  under  this  article;  eacl 
lot  or  parcel  liable  to  pay  the  same,  and  the  amoun 
chargeable  to  each.  The  board  of  supervisors  shall  lev; 
such  sums  against  the  property  liable,  and  shall  statj 
the  amount  of  the  tax  in  a  separate  column  in  the  an: 
nual  tax-roll  under  the  name  "  sewer  tax."  Such  ta: 
when  collected  shall  be  paid  to  the  supervisor  and  b 
by  him  applied  in  payment  of  the  bonds.  An  unpai< 
assessment  shall  be  collected  in  the  same  manner  ani 


TOWX   SEWERS  95 

shall  subject  the  land  and  land  owner  liable  therefor,  to 
the  same  interest,  burdens  and  penalties,  as  other  town 
taxes  in  arrears. 

§  7.  Section  two  hundred  and  forty-one  of  said  chap- 
ter is  hereby  amended  to  read  as  follows: 

§  238.  Appeal  from  apportionment. — ^A  person  ag- 
grieved by  an  apportionment  may,  within  fifteen  days 
after  the  filing  thereof,  appeal  therefrom  to  the  county 
court  of  the  county  in  which  such  district  is  situated. 
Such  appeal  shall  be  taken  by  a  notice  stating  the 
grounds  thereof,  served  personally  or  by  mail  upon  each 
of  the  sewer  commissioners  and  filed  with  the  town 
clerk. 

§  239.  Hearing  of  appeal. —  Either  party  may  bring 
on  the  appeal  on  a  notice  of  not  less  than  ten  nor 
more  than  twenty  days.  All  appeals  from  the  same  ap- 
portionment must  be  consolidated  and  heard  as  one  ap- 
peal. The  county  court  may  affirm  or  reverse  the  appor- 
tionment. If  it  be  reversed  on  the  ground  that  it  is 
erroneous,  unequal  or  inequitable,  the  court  shall,  by 
order  of  reversal,  appoint  three  disinterested  freeholders 
of  the  district  as  commissioners  to  make  a  new  appor- 
tionment, and  no  appeal  shall  be  allowed  from  such 
order. 

§  240.  Reapportionment. — ^A  reapportionment  shall  be 
made  in  the  following  cases: 

1.  By  the  commissioners  appointed  by  the  county 
court  where  the  original  apportionment  is  reversed  on 
the  ground  that  it  is  erroneous,  unequal  or  inequitable, 

2.  .By  the  sewer  commissioners  of  the  districts  where 
the  original  apportionment  is  reversed  on  any  other 
ground.  A  reapportionment  under  this  subdivision  shall 
be  made  in  like  manner  as  the  original. 


96  THE   PUBLIC    HEALTH   LAW 

§  241.  Procedure  by  new  commissioners. —  The  com- 
missioners appointed  by  tlie  county  court  shall  give 
notice  of  the  time  and  place  at  which  they  will  meet 
to  make  such  reapportionment,  and  shall  serve  notice 
thereof,  either  personally  or  by  mail,  at  least  ten  days 
before  such  meeting  upon  each  owner  of  land  within 
such  district  or  extension  of  an  existing  district,  as 
finally  fixed  by  the  board  of  sewer  commissioners.  They 
shall  meet  at  the  time  and  place  specified  and  make 
such  reapportionment  in  the  manner  herein  prescribed 
for  the  sewer  commissioners.  They  shall  file  such  reap- 
portionment in  the  office  of  the  town  clerk,  and  it  shall 
be  final  and  conclusive. 

§  8.  Section  two  hundred  and  forty-two  of  said  chap- 
ter is  hereby  amended  to  read  as  follows: 

§  242.  Fees  of  commissioners. —  Eaeh  commissioner  ap- 
pointed by  the  county  court  is  entitled  to  five  dollars 
for  each  day  necessarily  spent  in  making  such  reappor- 
tionment, besides  his  actual  necessary  expenses.  Such 
fees  and  expenses  are  a  charge  against  the  town,  and 
must  be  audited  by  the  town  board.  The  amount  thereof 
shall  be  added  to  the  portion  of  the  expense  of  con- 
structing such  sewer  or  sewer  system,  which  is  to  be 
assessed  against  property  in  such  sewer  district  or  ex- 
tension. 

§  9.  Section  two  hundred  and  forty-three  of  said  chap- 
ter is  hereby  amended  to  read  as  follows: 

§  243.  Expense  of  maintenance,  how  raised. — After 
the  sewer  system  is  constructed  it  shall  be  maintained 
by  the  commissioners,  and  the  cost  of  such  maintenance 
shall  be  a  charge  upon  the  sewer  district.  In  July  of 
each  year,  the  sewer  commissioners  shall  present  to  the 
town  board  an  estimate  of  the  amount  of  money  re- 
quii'ed  by  said  commissioners  to  meet  the  expenses  of 


TOWN  SEWERS  97 

maintainiug  the  sewer  system  for  the  ensuing  year. 
The  town  board  shall  formally  pass  upon  such  estimate 
and  approve,  or  correct  and  approve,  the  same.  The 
sewer  commissioners  shall  thereupon  assess  the  amount 
of  the  estimate  as  so  approved,  and  corrected,  on  the 
lands  within  their  district,  in  proportion,  as  nearly  as 
may  be,  to  the  benefit  which  each  lot  or  parcel  will  de- 
rive *therefrom,  and  shall  give  the  same  notice  thereof, 
and  shall  correct  and  file  such  apportionment  in  the 
same  manner,  and  shall  give  the  same  notice  of  the 
filing  of  such  corrected  apportionment,  as  is  provided 
for  in  section  two  hundred  and  thirty-seven  of  this 
chapter.  An  appeal  may  be  taken  from  such  corrected 
apportionment  within  the  same  time,  and  the  procedure 
thereupon  shall  be  the  same  as  specified  in  sections  two 
hundred  and  thirty-eight  to  two  hundred  and  forty- 
two,  both  inclusive,  of  this  chapter,  except  that  the  fees 
of  the  commissioners  appointed  by  the  county  court  to 
readjust  the  apportionment  made  pursuant  to  this  sec- 
tion shall  be  a  charge  upon  the  sewer  district,  and  shall 
be  included  in  the  expenses  of  maintenance.  "\\Tienever 
an  apportionment  is  to  be  made  to  meet  an  instalment 
Df  principal  and  interest  on  the  bonds  issued  pm'suant 
to  section  two  hundred  and  thirty-seven  of  this  chap- 
ter, any  proceedings  for  the  correction,  review  or  read- 
justment thereof  shall  be  consolidated  with  the  like 
proceedings,  if  any,  with  respect  to  the  apportionment 
nade  as  provided  in  this  section.  The  town  board  shall 
present  such  estimate  to  the  board  of  supervisors  at  its 
innual  meeting,  with  a  statement  of  each  property  or 
barcel  liable  for  the  same  and  the  amount  chargeable  to 
!ach.  The  board  of  supervisors  shall  levy  such  sums 
igainst  the  property  liable  and  shall  state  the  amoimt 
)f  tax  in  the  annual  tax  roll  under  the  name  "  sewer 

*  So  in  original. 


98  PUBUC  HEALTH   MANUAL 

tax,"  witli  the  sewer  tax  to  be  raised  for  payment  of 
bonds  as  provided  in  section  two  hundred  and  thirty- 
seven  of  this  chapter,  and  after  such  bonds  shall  have 
been  entirely  paid  in  a  similar  column  headed  "  sewer 
tax."  This  tax  for  maintenance,  when  collected,  shall 
be  paid  to  the  supervisor  of  the  town  and  by  him  paid 
to  the  sewer  commissioners  to  meet  the  expense  of 
maintenance  of  the  sewer  system.  An  unpaid  assess- 
ment under  this  section  shall  be  collected  in  the  manner 
provided  for  in  section  two  hundred  and  thirty-seven  of 
this  chapter.  The  sewer  system  as  so  constructed,  or  as 
hereafter  added  to  or  changed,  shall  be  under  the  charge 
and  control  of  the  sewer  commissioners,  under  whose 
supervision  it  shall  be  used  by  property  owners,  and  no 
person  shall  enter  into,  open  or  interfere  with  or  use 
said  sewer  system  except  under  the  inspection  and  di- 
rection of  said  sewer  commissioners  and  after  formal 
permission  shall  have  been  given  by  said  commissioners. 
The  sewer  commissioners  shall  adopt  rules  and  regula- 
tions to  govern  the  maintenance  and  use  of  the  sewer 
system  and  shall  therein  fix  the  amount  of  fees  that 
shall  be  chargeable  to  individuals  or  property  owners 
who  may  wish  to  enter  or  use  the  sewer  system,  which  | 
fees  shall  be  sufficient  in  amount  to  pay  for  the  cost  of  ; 
inspection  of  such  entry  or  entries.  Any  person  violat-  l 
ing  any  provisions  hereof  and  interfering  with,  entering 
or  using  said  sewer  system  without  obtaining  such  per- ! 
mission  shall  be  guilty  of  a  misdemeanor  and  liable  to  ' 
punishment  accordingly. 

§  10.  Section  two  hundred  and  forty-four  of  said 
chapter  is  hereby  amended  to  read  as  follows: 

§  244.  Annual  statement  of  commissioners. —  The 
sewer  commissioners  shall  in  the  month  of  December  in 
each  year  file  in  the  office  of  the  town  clerk  a  detailed 
statement,  under  oath,  of  the  moneys  received  and  paid 


7.:  TOWN    SE"WEES  99 

by  them  since  their  last  statement  under  the  provisions 
of  this  chapter,  together  with  the  names  of  the  persons 
or  parties  from  whom  the  same  were  received  and  to 
whom  the  same  were  paid,  and  the  object  of  each  pay- 
ment, with  the  vouchers  therefor.  Such  statement  shall 
show  the  balance  remaining  in  their  hands,  which  bal- 
ance shall  be  applied  to  maintenance  account  for  the 
following  year. 

§  11.  Section    two    hundred    and    forty-five    of    this 
chapter  is  hereby  repealed. 


lOO  PUBLIC   HEALTH   MANUAL 

RULES  AND  REGULATIONS  FOR  THE  PREPARA- 
TION AND  SUBMISSION  OF  PLANS  FOR  SEWER- 
AGE SYSTEMS  AND  SEWAGE  DISPOSAL  WORKS 

In  accordance  with  section  *77  of  article  V  of  the 
Public  Health  Law,  with  section  *260  of  article  XI  of 
the  Village  Law,  and  with  section  *233  of  article  XI  of 
the  Town  Law,  providing  for  the  submission  and  ap- 
proval of  plans  for  the  sewerage  systems  and  for  the 
issuance  of  permits  for  the  discharge  of  sewage  into 
the  waters  of  the  State,  the  following  rules  and  regu- 
lations have  been  adopted  by  the  State  Commissioner 
of  Health,  covering  the  preparation  and  submission  of 
plans  for  systems  of  sewerage  and  sewage  disposal, 
and  extensions  thereof. 

1.  General  plans. —  General  plans  on  a  scale  of  not 
less  than  300  feet  to  one  inch,  and  preferably  not 
great-er  than  100  feet  to  one  inch,  covering  the  entire 
area  of  the  municipality,  must  accompany  every  applica- 
tion in  the  case  of  a  new  sewer  system,  or  any  extension 
or  modification  of  any  existing  sewer  system,  unless 
such  a  general  plan  of  the  entire  area  of  the  munici- 
pality has  already  been  submitted.  These  plans  must 
have  shown  upon  them  all  existing  and  proposed  streets, 
the  surface  elevation  at  all  street  intersections  and  at 
all  points  where  changes  of  grade  occur,  and  contour 
lines  for  intervals  of  not  less  than  5  nor  more  than  10 
feet.  The  plans  must  also  show  sewers  upon  all  streets 
in  the  municipality  or  the  sewerage  district,  even  if 
the  construction  of  some  of  the  sewers  may  be  deferred. 
Should  there  be  areas,  which  on  account  of  the  topo- 
graphy, or  for  other  reasons,  cannot  drain  into  the  pro- 
posed system,   a  definite  statement  to  this   effect  must 

*  See  pages  43,  79  and  90. 


SEWEEA6E  SYSTEMS  101 

be  made  in  the  engineer's  report  and  the  probable  future 
drainage  of  this  disregarded  territory  discussed.  The 
plans  must  also  show  clearly  the  location  of  all  existing 
"  sanitary "  and  ''  combined "  sewers,  but  not  of  drains 
used  exclusively  for  sub-soils  or  for  siu-face  water;  the 
location  and  general  arrangement  of  existing  and  pro- 
posed sewage  disposal  Avorks,  and  the  location  of  all 
existing  and  proposed  outlets.  The  magnetic  meridian, 
title  and  date,  and  the  direction  of  flow  and  mean  water 
elevation  of  the  principal  streams,  must  also  be  clearly 
shown. 

2.  Lettering,  figures  and  symbols.— The  lettering  and 
figures  must  be  of  appropriate  size,  and  of  distinct  out- 
line. Surface  elevations  should  preferably  be  placed 
just  outside  street  lines  opposite  their  respective  posi- 
tions, and  at  street  corners,  preferably  in  the  angle  out- 
side street  line,  in  the  upper  right  angle  if  but  one,  and 
in  the  other  angles  if  more  than  one.  The  elevations 
of  all  sewer  inverts  must  be  shown  at  street  intersec- 
tions, at  the  ends  of  all  lines,  and  at  all  points  where 
changes  in  alignment  and  grade  occur.  These  elevations 
must  be  clearly  and  distinctly  written  close  to  the  man- 
hole or  flush  tank,  parallel  with  sewer  line,  and  ex- 
pressed at  least  to  the  nearest  1/10  foot.  All  manholes, 
flush  tanks,  catch  basins,  lampholes  and  other  appur- 
tenances must  be  shown  upon  the  plans  in  suitable 
symbols  appropriately  "'•  referenced "  in  the  title.  The 
sizes  and  the  gradients  of  all  proposed  sewers,  and  of 
existing  sewers,  must  be  marked  appropriately  along 
sewer  lines  between  all  consecutive  manholes  or  flush 
tanks,  with  arrows  showing  the  direction  of  flow.  All 
sewers  and  other  appurtenances  must  be  shown  by 
black  lines  and  conventional  signs,  and  not  by  colors. 
As  an  example  of  the  lettering  to  be  used  at  a  street 
intersection,  the  following  sketch  is  offered: 


102 


PUBLIC    HEALTH    MANUAL 


SE^-ZEAGE    SYSTEMS  103 

3.  Profiles. —  Profiles  upon  separate  steets,  showing  all 
sewers  12  inches  or  more  in  diameter,,  and  all  main 
intercepting  and  outfall  sewers  when  less  than  12 
inches  in  diameter,  and  all  other  arailable  profiles, 
must  be  submitted  with  the  plans.  Upon  these  pro- 
files must  be  shown  all  manholes,  flush  tanks,  inverted 
siphons  and  other  appurtenances.  The  horizontal  scale 
of  these  profiles  must  be  at  least  as  great  as  the  scale 
of  the  corresponding  plans,  and  the  rertical  scales  not 
less  than  10  feet  to  one  inch.  Both  scales  must  be 
clearly  shown  upon  the  profiles.  Figures  showing  the 
sizes  and  gradients  of  sewers,  the  surface  elevations 
and  sewer  inverts,  must  be  shown  upon  the  profiles 
with  the  same  frequency,  or  at  the  same  points,  as 
shown  upon  the  plans.  All  stream  crossings  and  sewer 
outlets  must  be  shown  upon  profiles  with  elevations  of 
stream  bed,  and.  the  normal,  high  and  low  water  levels, 
if  these  data  are  available. 

4.  Detail  plans. —  I'a)  Detailed  plans  of  sewer  sections 
and  of  all  ordinary  sewer  appurtenances,  such  as  man- 
holes, flush  tanks,  inspection  chambers,  inverted  siphons, 
as  well  as  of  any  special  appurtenance  or  structure, 
must  accompany  general  sewer  plans.  These  detail 
plans  must  be  drawn  to  such  a  scale  as  to  show  suit- 
ably and  clearly  the  nature  of  the  design  and  all  details, 
such  as  manhole  frames  and  covers,  iron  pipes  and 
valves,  flushing  gates,  siphons,  etc.  They  should  have 
marked  upon  them  all  dimensions,  grades  and  explana- 
tory notes  necessary  to  make  them  readily  intelligible 
and  a  complete  guide  for  construction. 

(b)  Complete  detailed  plans  for  sewage  disposal 
works  must  be  submitted  in  all  cases  where  it  is  pro- 
posed to  construct  works  for  complete  purification  at 
the  time  of  the  construction  of  the  sewerage  system. 
If,  however,  it  is  proposed  to  construct  only  a  portion 


104  PUBLIC    HEALTH    MANUAL 

of  the  complete  works,  at  this  time,  detailed  plans  of 
such  portions  only  need  be  submitted.  In  the  latter 
case  future  provision  must  always  be  made  for  complete 
purification  works,  and  a  reserve  area  must  be  shown 
upon  the  general  plans  for  these  works,  and,  if  possible, 
a  statement  of  the  general  type  or  method  which  it  is 
proposed  to  adopt  when  complete  purification  works 
may  be  required. 

5.  Specifications,  estimates  of  cost. —  Specifications  for 
the  construction  of  the  system  of  sewers  and  sewage 
disposal  works,  including  estimates  of  cost  of  the  same, 
where  these  have  been  made,  must  accompany  all  plans 
for  original  or  new  systems.  With  plans  for  exten- 
sions of  existing  systems,  specifications  may  be  omitted, 
provided  these  extensions  are  to  be  constructed  in  ac- 
cordance with  specifications  filed  previously  with  origi- 
nal plans. 

6.  Engineer's  report. — A  report,  which  would  usually 
be  written  by  the  designing  engineer,  must  be  presented 
with  all  plans  for  original  systems,  giving  full  informa- 
tion upon  which  the  design  is  based.  This  report  must 
include  a  description  of  the  extent  of  area  which  it  is 
proposed  to  include  within  the  system  at  the  present 
time  and  in  the  future;  the  estimated,  present  and 
future  population  to  be  served;  the  estimated  per  capita 
rates  or  volume  of  sewage  to  be  provided  for ;  the 
allowance,  if  any,  for  storm  or  roof  water,  and  the 
full  reasons  for  the  inclusion  of  such  water  in  the 
system.  The  report  should  include  a  description  of  ? 
conditions  peculiar  to  the  locality,  affecting  in  any  way 
the  desigii  of  the  system;  a  description  of  all  special 
devices  used  in  the  design  and  of  any  special  points  to 
be  observed  in  the  maintenance  and  operation  of  the 
system.     The  report  must  contain  a  full  description  of 


SEwzEAGE  Systems  lOo 

the  general  arrangement  and  all  special  features  of  the 
proposed  sewage  disposal  works,  the  reasons  for  the 
choice  of  the  method  or  type  proposed  and  a  full  de- 
scription of  the  proposed  operation  of  the  plant.  A  full 
statement  must  be  given  of  the  capacities  of  the  various 
parts  of  the  works,  the  population  which  the  works  are 
designed  to  serve  and  the  reasons  for  any  unusual 
capacities   adopted. 

7.  General  requirements. —  (a)  All  plans,  specifications 
and  reports  must  be  submitted  in  duplicate,  and  the 
application  for  approval  must  be  submitted  on  blanks 
issued  by  the  Department  for  the  purpo&e  and  signed  by 
the  proper  municipal  authorities  or  their  properly  au- 
thorized "agent  (in  the  latter  case  a  letter  of  authoriza- 
tion must  accompany  the  application).  If  approved, 
the  original  set  will  in  general  be  returned  and  the 
duplicate  set,  if  clear  and  distinct  prints,  on  suitable 
paper  or  cloth,  will  be  filed  with  the  Department  accord- 
ing to  law. 

(b)  In  general,  and  except  in  certain  restricted  dis- 
tricts and  for  very  cogent  reasons,  the  Department  will 
approve  of  plans  for  new  systems  only  when  designed 
upon  the  "  separate  "  plan,  in  which  all  rain  water  from 
roofs,  streets  and  other  areas,  and  all  ground  water 
other  than  unavoidable  leakage  and  a  very  restricted 
allowance  for  cellar  drainage,  shall  be  excluded.  When 
plans  for  the  extension  of  "  combined  ''  sewers,  already 
built  and  in  operation  in  full  accordance  with  the  pro- 
visions of  the  Health  Law,  are  submitted,  approval  will 
in  general  be  given  only  in  cases  where  the  district 
tributary  to  the  sewer  extension  is  of  limited  area  and 
cannot  be  included  in  a  new  and.  distinct  sewer  district 
constructed  upon  the  "  separate' "  plan. 

(c)  The  Department  will  in  general  approve  only  of 
plans  which  include  disposal   works  for   such  complete 


106  PUBLIC   HEALTH   MANUAL 

purification  as  will  produce  a  clear  and  "  stable " 
eflBiuent.  If  it  is  proposed  to  omit  certain  portions 
of  these  works  for  the  complete  purification  of  the 
sewage,  there  must  be  shown  upon  the  plan  a  reserve 
area  and  the  general  arrangement  of  the  type^  methods 
and  devices  which  it  is  proposed  to  install  in  the  future 
when  such  complete  works  are  required;  and  included 
in  the  engineer's  report  the  full  reasons  why  any  of 
such  portions  of  the  complete  works  are  temporarily 
omitted. 

(d)  The  approval  of  the  Department  is  not  required 
by  law  for  drains  designed  and  used  exclusively  for 
storm  water,  sub-soil  water  and  for  other  purposes  of 
drainage  where  no  sewage  or  wastes  are  allowed  to 
enter  them.  If  any  sewage  or  other  waste  matter  or 
products  are  discharged  into  such  drains,  they  come 
under  the  definition  and  classification  of  sewers,  for 
which  the  approval  of  the  Department,  and  a  permit 
therefrom,  must  be  secured  in  accordance  with  the  Pub- 
lic Health  Law  and  the  above  regulations. 


VILLAGE    BUILDING    CODE  107 

VILLAGE  BUILDING  CODE 

Chap.  202,  Laws  of  1910 

AK  act  to  amend  the  village  law,  in  relation  to  adop- 
tion and  enforcement  of  building  and  sanitary  codes 
in  village  of  the  first  class. 

Section  1.  Chapter  sixty-four  of  the  laws  of  nineteen 
hundred  and  nine,  entitled  "An  act  relating  to  villages, 
constituting  chapter  sixty-four  of  the  consolidated  laws," 
is  hereby  amended  by  adding  thereto,  after  section 
ninety  thereof,  a  new  section,  to  be  section  ninety-a,  to 
read  as  follows: 

§  90-a.  Building  and  sanitary  codes. —  The  board  of 

trustees  of  any  village  of  the  first  class,  whether  or- 
ganized under  a  general  or  special  act,  may,  by  a 
majority  vote  of  all  of  said  board  at  a  meeting  thereof 
duly  held,  taken  and  recorded  by  calling  the  ayes  and 
noes  adopt  an  ordinance  to  be  known  as  the  building 
code,  which  shall  provide  therein  rules  and  regulations 
for  the  construction,  alteration,  removal  and  inspection 
of  all  buildings  or  structures  erected  or  to  be  erected 
iwithin  the  limits  of  the  village,  providing  therein  and 
regulating  thereby  the  plans  and  means  of  all  such  con- 
struction, alteration  or  removal  of  all  such  buildings 
,and  structures.  Said  board  by  a  majority  vote  of  all 
of  said  board,  at  a  meeting  thereof  duly  held,  taken 
and  recorded  by  calling  the  ayes  and  noes,  may  also 
adopt  an  ordinance  to  be  known  as  the  sanitary  code, 
which  shall  provide  therein  rules  and  regulations  for 
the  construction,  alteration,  removal  and  inspection  of 
all  plumbing  and  drainage  systems  in  buildings  now 
erected  or  to  be  erected  upon  property  within  the  limits 
of  the  village,  providing  therein  and  regulating  thereby 


108  PUBLIC   HEAITH   MANTJAX 

all  such  construction^  alteration  or  removal  of  all  sue 
plumbing  and  drainage,  and  the  licensing  of  plumbei 
to  do  such  work.  Said  board  shall  have  authority  i 
provide  penalties  or  punishments  for  disobedience  t 
said  ordinances  in  the  manner  prescribed  by  sectio 
ninety-three  of  this  chapter  and  may  appoint  and  r( 
move  such  inspectors  and  examiners  as  may  be  require 
to  properly  execute  the  provisions  of  said  ordinance 
and  shall  possess  authority  to  alter  and  amend  sal 
ordinances  from  time  to  time  and  to  issue  licenses 
plumbers  and  builders  by  a  like  vote.  Nothing  herei 
contained  shall  impair  any  other  power  conferred  by  laT 
upon  a  board  of  trustees  in  relation  to  the  same  o 
kindred  matters. 


SAXIT^EY  EEG^XATIO^'S  109 


SANITARY  REGULATIONS 

Recommended  for  Adoption  ly  Local  Boards  of  Health 

(Xot€. —  EverY  local  board  of  health  should  adopt 
such  sanitary  regulations  as  are  necessary  to  carry 
out  the  proyisions  of  the  Public  Health  Law.  and  may 
adopt  any  ordinance  required  by  local  conditions  to 
protect  the  public  health.  A  fixed  penalty  should  be 
stated  in  each  case.) 

§  1.  Nuisances  defined. —  AATiatever  is  injurious  or 
dangerous  to  human  life  or  health;  whateyer  building, 
or  part  of  cellar  thereof,  is  oyercrowded  or  not  pro- 
vided with  adequate  means  of  ingress  and  egress,  or 
is  not  sufficiently  supported,  yentilated,  sewered,  drained, 
lighted  or  cleaned;  and  whateyer  renders  soil,  air,  water 
or  food  impure  or  unwholesome,  are  declared  to  be 
nuisances  and  to  be  illegal;  and  eyery  person  haying 
aided  in  creating  or  contributing  to  the  same,  or  who 
may  support,  continue  or  retain  any  of  them,  shall  be 
deemed  guilty  of  a  yiolation  of  this  ordinance,  and  shall 
be  liable  for  any  penalty  prescribed  and  for  the  expense 
of  the  abatement  or  remedy  required. 

§  2.  Privies,  cess-pools,  etc. —  No  privy-pit,  cess-pool 
or  reservoir  into  which  any  privy,  water-closet,  stable, 
sink  or  other  receptacle  of  refuse  or  sewage,  is  drained, 
shall  be  constructed  or  maintained  in  any  situation 
or  in  any  manner  whereby,  through  leakage  or  overflow 
of  its  contents,  it  may  cause  pollution  of  the  soil  near 
or  about  habitations,  or  of  any  well,  spring  or  other 
source  of  water  used  for  drinking  or  culinary  purposes; 
nor  shall  the  overflow  from  any  such  reservoir  or  re- 
ceptacle be  permitted  to  discharge  into  any  public 
place  or  in  anywise  whereby  injury  or  danger  to  health 


110  PUBLIC   HEAITH   LTANUAL 

inay  be  caused.  And  every  such  pit,  reservoir  or  rt 
ceptacle  shall  be  cleaned  and  the  contents  thereo 
removed  at  such  times  and  under  such  precautions  a 
the  board  of  health  may  prescribe.  No  such  pit,  resei 
voir  or  receptacle  shall  be  constructed  or  maintaine 
in  such  a  manner  that  the  contents  thereof  shall  b 
accessible  to  flies.     Any  violation  of  this  ordinance  shal 

subject  the  ofifending  party  to  a  penalty  of 

for  each  offense  and  for  each  day's  continuance  or  repeti 
tion  of  the  offense. 

§  3.  Stables,  barns,  etc. — ^All  stables,  barns  and  othe 
places  wherein  horses  or  cattle  are  kept  shall  be  kep 
in  a  clean  and  sanitary  condition.  All  accumulation 
of  manure  shall  be  stored  in  such  places,  and  be  remove' 
with  such  frequency  and  in  such  manner  as  to  preven 
offensive  or  noxious  odors.  iNot  more  than  two  load 
of  horse  or  cow  manure  shall  be  allowed  to  accumulat 

on  any  premises  within  the   limits  and  n 

piles  of  manure  shall  be  allowed  to  accumulate  in  an; 
position  or  manner  whereby  they  shall  become  breedinj 
places  of  flies  or  whereby  any  leachings  therefron 
may  pass  into  any  stream  or  watercourse.  Any  viola 
tion  of  this  ordinance  shall  subject  the  ofi"ending  part; 

to  a  penalty  of   ,  for  each  offense  and  f o 

each  day's  continuance  or  repetition  of  the  offense.       ; 


§  4.  Pig-pens,  chicken-yards,  etc. —  No  pig-pen  and  n< 

chicken,  duck  or  other  fowl  yard  or  pen,  shall  be  buil 

or   maintained  in  the    without   the  approval  o 

the  board  of  health;  nor  shall  any  pig-pen,  chicken,  o 

other  fowl  yard  be  maintained  within feet  of  an; 

stream  or  within feet  of  any  street  or  dwelling 

All  such  pens  or  yards  shall  be  kept  in  a  clean  an 
sanitary  condition  and  all  filth  accumulating  in  or  abou 
the  same  shall  be  removed  with  such  frequency  and  ii 


I 


SANITAEY  EEeUXATIONS  111 


such  manner  as  the  tMDard  may  direct.  Tlie  board  of 
health  may  declare  the  keeping  or  maintaining  of  swine, 
or  of  chickens,  ducks  or  other  fowl,  within  certain  pre- 
scribed limits  within  the    a  nuisance  and  order 

the  discontinuance  and  removal  of  the  same.  Any 
violation  of   this  ordinance  shall  subject  the  offending 

party  to  a  penalty  of ,  for  each  offense  and 

for  each  day's  continuance  or  repetition  of  the  offense. 

§  5.  Sewers,  drains,  etc. — All  house-sewers  or  drains 
for  the  conveyance  of  excreta,  wash  water,  sink  water, 
or  other  deleterious  or  offensive  matters  shall  be  water- 
tight, and  the  plans  and  methods  of  their  construction 
shall  be  subject  to  the  approval  of  the  board  of  health, 
and  conform  to  all  provisions  of  plumbing,  drainage  or 
sewerage  ordinances  which  may  have  been  established 
and  are  in  force.  In  streets  or  avenues  where  public 
sewers  are  or  shall  be  constructed,  the  board  of  health 
may  declare  all  privies,  cesspools,  or  other  receptacles 
used  for  deposition  of  sewage  matters  to  be  nuisances 
and  order  them  discontinued,  cleaned  and  filled  and  the 
houses  connected  with  said  sewers.  Any  violation  of 
this  ordinance   shall   subject   the   offending  party  to   a 

penalty  of    ,  for  each  offense  and  for  each 

day's  continuance  or  repetition  of  the  offense. 

§    6.  House-refuse,    garbage,    etc. —  No    house-refuse, 

offal,  garbage,  dead  animals,  decaying  vegetable  matter, 
or  organic  waste  substance  of  any  kind,  shall  be  thrown 
upon  any  street,  road  or  public  place,  and  no  such  refuse, 
putrescible  or  decaying  animal  or  vegetable  matter  shall 
be  kept  in  any  house,  cellar  or  adjoining  outbuildings 
or  premises  for  more  than  twenty-four  hours.  All  re- 
ceptacles for  such  garbage,  etc.,  shall  be  water-tigtit 
and  be  provided  with  a  suitable  cover  which  must  be 
kept  properly  adjusted  to  the  same.     Any  violation  of 


112  PUBLIC    HEALTH    MANUAL 

this  ordinance  shall   subject   the  offending  party   to   a 

penalty  of    ,  for  each  offense  and  for  each 

day's  continuance  or  repetition  of  the  offense. 

§  7.  Filled  in  or  made  land. —  Xo  filling- in  or  making 
of  land  by  the  dumping  of  rubbish  or  other  material 
shall  be  done  unless  approved  by  the  board  of  health; 
and  no  garbage,  offal,  dead  animals  or  other  vegetable, 
organic  or  putrescible  matter  or  admixture  thereof  shall 
be  used  for  filling  in  low  lands,  nor  be  desposited  in  any 
other  places,  nor  in  any  manner,  unless  approved  by 
the  board  of  health.     Any  violation  of  this  ordinance 

shall  subject  the  offending  party  to  a  penalty  of , 

for  each  offense  and  for  each  day's  continuance  or  repe- 
tition of  the  offense. 

§  8.  Noxious  trades. —  Xo  person,  or  company  shall 
erect  or  maintain  any  manufactory  or  place  of  business 
dangerous  to  life  or  detrimental  to  health,  or  where  un- 
wholesome, offensive  or  deleterious  odors,  gas,  smoke, 
deposits,  or  exhalations  are  generated  or  emitted,  with- 
out the  approval  of  the  board  of  health,  and  all  such 
establishments  shall  be  maintained  in  a  clean  and  whole- 
some condition  free  from  offense  or  prejudice  to  public 
health;  nor  shall  any  offensive  or  deleterious  waste 
substance,  gas-tar,  chemicals,  sludge,  refuse  or  injurious 
or  offensive  matter  be  allowed  to  accumulate  upon  the 
premises  or  be  thrown  or  allowed  to  run  into  any  public 
waters,  stream,  watercourse,  street  or  public  place.  And 
every  person  or  company  conducting  such  manufacture 
or  business  shall  use  the  best  approved  and  all  reason- 
able means  to  prevent  the  escape  of  smoke,  gases  and 
odors,  and  to  protect  the  health  and  safety  and  comfort 
of  all  persons  residing  near  or  employed  within  said 
manufactory.  Any  violation  of  this  ordinance  shall  sub- 
ject the  offending  party  to  a  penalty  of   . . . .....,..., 


SANTTABY  EEGUXATIOXS  113 

m 

for  each  offense  and  for  each  day's  continuance  or  repe- 
tition of  the  offense. 

§  9.  Rendering  establishments.— Xo  garbage,  bone  or 
animal  boiling  or  rendering  occupations  shall  be  carried 
on  without  the  consent  of  the  board  of  health,  nor  in 
any  establishment  unless  provided  with  tight  walls,  im- 
pervious floors  and  such  provisions  for  adequate  water 
supply  and  drainage  and  other  facilities  as  will  enable 
all  operations  to  be  carried  on  with  cleanliness  and  free- 
dom from  all  offense  or  nuisance.  Xo  such  occupation 
shall  be  carried  on,  nor  shall  any  establishment  be  con- 
structed or  maintained,  in  or  near  a  thickly  inhabited 
neighborhood,  nor  shall  the  drainage  from  any  estab- 
lishment, unless  subjected  to  purification,  be  permitt-id 
to  flow  into  any  stream  or  watercourse.  Any  violation 
of  this  ordinance  shall  subject  the  offending  party  to  a 

penalty  of    ,  for  each  offense  and  for  each 

day's  continuance  or  repetition  of  the  offense. 

§  10.  Unwholesome  food. —  Xo  meat,  fish,  bird,  fruit, 
vegetables,  milk,  or  anything  for  human  food  or  drink, 
not  being  then  fresh  or  properly  preserved,  sound, 
wholesome  and  safe  for  such  use;  nor  any  flesh  of  any 
animal  which  died  by  disease  or  which  was  at  the  time 
of  its  death  in  a  sickly  or  unwholesome  condition;  nor 
the  carcass  or  meat  of  any  calf  which  was  at  the  date 
of  its  death  less  than  four  weeks  old,  or  of  any  lamb 
which  was  at  the  date  of  its  death  less  than  eight  weeks 
old,  or  of  any  pig  which  was  at  the  date  of  its  death 
less  than  five  weeks  old  shall  be  brought  within  the 
limits  of  this  municipality,  nor  offered  or  held  for  sale 
as  food  therein.     Any  violation  of  this  ordinance  shall 

subject  the  offending  party  to  a  penalty  of , 

for  each  offense  and  for  each  day's  continuance  or  repe- 
tition of  the  offense. 
8 


114  PUBLIC   HEALTH   MANUAL  ] 

§  11.  Exposure  of  food. — All  dealers  in  such  food  suj 
plies  as  are  liable  to  contamination  from  dirt  or  flie 
insects,  etc.,  such  as  milk,  meats,  fish,  vegetables,  fruit 
candies  and  cake,  must  provide  a  covering  of  some  sui 
able  material  to  protect  any  such  food  exposed  for  sa 
from  dust,  flies,  insects,  etc.  Any  violation  of  this  ord 
nance  shall  subject  the  oft'ending  party  to  a  penalty  < 

,  for  each  off"ense  and  for  each  day's  coi 

tinuance  or  repetition  of  the  offense. 

§  12.  Sale  of  ice. —  No  ice,  naturally  or  artificial! 
frozen  from  water,  taken  from  any  pond,  stream,  spring 
well  or  other  source  of  supply  vs^hich  has  been  contam 
inated,  or  is  otherwise  impure  or  unwholesome,  shall  b 
harvested,  manufactured,  sold,  or  exposed  or  offered  fo 
sale,  where  such  ice  may  be  used  in  contact  with  food 
or   beverages.      Any   violation   of   this    ordinance   sha] 

subject  the  offending  party  to  a  penalty  of 

for  each  offense  and  for  each  day's  continuance  or  repe 
tition  of  the  offense. 

§  13.  Disposal  of  dead  animals. —  Upon  the  death  o 

any  animal  within  the   ,  except  when  the  same  i 

killed  for  food,  the  owner  or  persons  having  contro 
thereof  shall  immediately  notify  the  board  of  healt] 
or  health  ofiicer,  and  remove  the  carcass  to  such  plac 
as  the  said  board  or  ofiicer  may  direct,  and  there  prop 
erly  dispose  of  the  same  in  a  manner  approved  h^ 
the  board  of  health.  Any  violation  of  this  ordi 
nance  shall  subject  the  offending  party  to  a  penalty  o 

,  for  each  offense  and  for  each  day's  con 

tinuance  or  repetition  of  the  offense. 

§  14.  Slaughter-houses,  markets,  etc.— No  person  oi 
persons,  without  the  consent  of  the  board  of  health,  shal 
build  or  use  any  slaughter-house,  within  the  limits  o: 


SANITAEY  REGULATIONS  115 

this  municipality  and  the  keeping  and  slaughtering  of 
all  cattle,  sheep  and  swine,  and  the  preparation  and 
keeping  of  all  meat,  fish,  birds,  or  other  animal  food, 
shall  be  in  the  manner  best  adapted  to  secure  and  con- 
tinue their  wholesomeness  as  food;  and  every  butcher 
or  other  person  owning,  leasing  or  occupying  any  place, 
room  or  building  wherein  any  cattle,  sheep  or  swine  have 
been  or  are  killed  or  dressed,  and  every  person  being  the 
owner,  lessee  or  occupant  of  any  room  or  stable  wherein 
any  animals  are  kept,  or  of  any  market,  public  or  pri- 
vate, shall  cause  such  place,  room,  building,  stable  or 
market,  and  their  yards  and  appurtenances,  to  be  thor- 
oughly cleansed  and  purified,  and  all  offal,  blood,  fat, 
garbage,  refuse  and  unwholesome  and  offensive  matter 
to  be  removed  therefrom  at  least  once  in  every  twenty- 
four  hours  after  the  use  thereof  for  any  of  the  purposes 
herein  referred  to,  and  shall  also  at  all  times  keep  all 
woodwork,  save  floors  and  counters,  in  any  building, 
place  or  premises  aforesaid  thoroughly  painted  or  white- 
washed; and  the  floors  of  such  building,  place  or  prem- 
ises shall  be  so  constructed  as  to  prevent  blood  or  foul 
liquids  or  washings  from  settling  in  the  earth  beneath. 
Any  violation  of  this  ordinance  shall  subject  the  offend- 
ing party  to  a  penalty  of ,  for  each  offense 

and  for  each  day's  continuance  or  repetition  of  the 
offense. 

§  15.  Notification  of  communicable  diseases. —  Every 
householder  or  head  of  family  in  a  house  wherein  any 
case  of  communicaile  disease  may  occur,  shall  report 
the  same  to  the  board  of  health  or  the  health  officer, 
within  twelve  hours  from  the  time  of  his  or  her  first 
knowledge  of  the  nature  of  such  disease.  Until  such 
report  has  been  received  by  such  board  of  health  or 
health  oflBcer  no  clothing  or  article  which  has  been  ex- 
posed to  infection  shall  be  removed  from  the  house;  nor 


116  PUBLIC   HEAITH   MANUAL 

shall  any  occupant  change  his  or  her  residence  elsewhere 
without  the  written  consent  of  the  health  officer  of  said 
board. 

Any  violation  of  this  ordinance  shall  subject  the  of- 
fending party  to  a  penalty  of   ,  for  each 

offense  and  for  each  day's  continuance  or  repetition  of| 
the  offense. 

§  16.  Physicians  shall  report  all  cases  within  twelve  I 
hours. —  Every  physician  who  shall  be  called  to  attend 
a  communicable  disease  or  knows  of  one  which  in  his 
opinion  has  not  been  reported,  shall  as  soon  as  he  de- 
termines its  nature  make  a  written  report  to  the  health 
officer  of  the  municipality  in  which  the  disease  prevails. 

This  report  shall  specify  the  name,  age  and  residence 
of  the  patient,  the  nature  of  the  disease,  and,  if  pos- 
sible, where  contracted  and  such  other  information  ob- 
tainable as  may  prove  important  to  the  health  authori- 
ties in  an  investigation  of  the  disease. 

Such  report  shall  be  made  within  twelve  hours  after 
the  nature  of  the  disease  has  been  determined  and 
shall  be  signed  by  the  physician  making  the  same. 

Diseases  to  he  reported. —  The  following  diseases  shall 
be  regarded  as  necessary  to  be  reported: 

Anterior  poliomyelitis,  anthrax,  bubonic  plague,  cancer, 
cerebrospinal  meningitis,  cholera,  diphtheria,  hydropho- 
bia, leprosy,  measles,  ophthalmia  neonatorum,  pellagra, 
pneumonia,  scarlet  fever,  smallpox,  tetanus,  tubercu- 
losis, typhoid  fever,  typhus  fever,  whooping  cough, 
chickenpox  and  yellow  fever. 

Any  violation  of  this  ordinance  shall  subject  the  of- 
fending  party    to   a    penalty   of    ,   for   each 

offense. 


SAI^ITAEY  EEGUIATIONS  117 

§  17.  Quarantine  notice. —  Having  been  notified  of  the 
existence  of  a  case  of  communicable  disease,  or  being 
cognizant  of  such,  it  shall  be  the  duty  of  the  health 
officer,  as  hereinafter  defined,  to  at  once  place  on  a 
conspicuous  part  of  the  house  in  which  such  patient 
resides,  or  lodges,  an  official  quarantine  card,  announc- 
ing the  name  of  the  disease  within,  and  forbidding 
ingress  or  egress  to  or  from  such  house,  except  as  per- 
mitted by  the  rules  and  regulations  of  the  board  of 
health,  or  upon  the  written  consent  of  the  health  officer 
of  such  board. 

No  person  shall,  after  the  establishment  of  such  quar- 
antine, enter  or  leave  such  house,  except  as  permitted 
by  the  regulations  of  the  board  of  health,  or  the  health 
officer,  nor  shall  any  person  remove  from  such  house 
any  article  of  clothing  or  other  possibly  infected  ob- 
jects, nor  mar  nor  remove  the  quarantine  card  or  notice, 
without  the  consent  of  either  the  board  of  health  or 
the  health  officer  of  said  board. 

During  the  maintenance  of  such  quarantine  no  child 
or  teacher  residing  in  such  quarantined  house  shall  be 
perm'tted  to  attend  school  or  other  public  gatherings, 
unless  the  same  shall  be  permitted  by  the  board  of 
health. 

Degrees  of  quarantine  defined  and  diseases  included  in 
each. — Absolute  quarantine. — An  absolute  quarantine  is 
one  in  which  the  admission  to,  or  exit  from  the  build- 
ing, of  all  persons  is  enforced,  except  of  the  attending 
physician,  the  health  officer,  or  other  representative 
of  the  board  of  health,  and  the  passing  out  of  any  ob- 
ject or  material  from  the  quarantined  house  is  abso- 
lutely prohibited.  The  municipality  shall  be  responsi- 
ble for  the  supply  to  the  people  so  quarantined  of  such 
provisions  as  may  be  needed  for  their  proper  care  and 


118  PUBLIC   HEAXTH  MANUAL 

maintenance,  together  with  a  nurse  or  nurses  when  the 
quarantined  people  are  unable  to  provide  the  same. 

Diseases  for  absolute  quarantine. —  When  any  one  of 
the  following  diseases  shall  exist  in  this  municipality 
an  absolute  quarantine,  as  above  defined,  shall  be  at  once 
established  and  maintained  until  the  same  has  been 
officially  removed  by  the  board  of  health,  or  its  execu- 
tive officer,  the  health  officer :  Bubonic  plague,  cholera, 
diphtheria,  leprosy,  scarlet  fever,  smallpox,  typhus 
fever  and  yellow  fever. 

Modified  quarantine. — A  modified  quarantine  is  one  in 
which  members  of  the  household  may  be  permitted  to 
pass  in  and  out  of  the  house  under  prescribed  regula- 
tions imposed  by  the  board  of  health  or  its  health 
officer;  in  which  both  patient  and  attendants  are  iso- 
lated, the  carrying  from  the  house  of  any  article  or 
material  is  prohibited,  unless  the  same  has  been  thor- 
oughly disinfected  according  to  the  rules  of  the  board 
of  health. 

Diseases  for  modified  quarantine. —  When  any  one  of 
the  following  diseases  shall  exist  in  this  municipality 
a  modified  quarantine,  as  above  defined,  shall  be  at  once 
established  and  maintained  until  the  same  has  been 
officially  removed  by  the  board  of  health  or  its  execu- 
tive, the  health  officer:  Anterior  poliomyelitis,  cerebro- 
spinal meningitis,  measles,  typhoid  fever  and  whooping 
cough. 

Observation  quarantine. — An  observation  quarantine 
is  one  in  which,  after  the  disease  has  been  reported  to 
the  board  of  health  or  the  health  officer,  the  health  officer 
shall   maintain    such  vigilance  or   observation   over   its 


SAXITAEY  REGUXATIOXS  119 

W 

)r€valeiice  as  in  his  judgment  may  he  necessary  to  best 
■onserve  the  healtli  of  the  people  ^^ithin  his  jurisdiction. 
Che  house  shall  not  be  placarded  under  this  degree  of 
[uarantine. 

Diseases  for  observation  quarantine. —  When  any  one 
>f  the  following  diseases  shall  exist  in  this  municipality 
t  shall  be  the  duty  of  the  health  officer  to  maintain  an 
)bservation  quarantine  as  above  defined  during  sucl 
;ime  as  may  in  his  judgment  seem  best:  Cancer,  rabies, 
etanus,  ophthalmia  neonatorum,  pneumonia,  tubercu- 
osis. 

§  17.  Importation  of  infected  persons  or  things.— ^N^o 
)erson  or  article  liable  to  propagate  a  communicable 
lisease  shall  be  brought  within  the  limits  of  this  munici- 
pality, unless  by  the  special  permit  and  direction  of  the 
ward  of  health;  and  any  one  having  knowledge  that 
mch  person  or  article  has  been  brought  within  such 
imits  shall  immediately  notify  the  said  board  thereof. 

Any  violation  of  this  ordinance  shall  subject  the 
)ffending  party  to  a  penalty  of 

§  18.  Exposure  of  infected  persons  or  things.— No 
person  shall,  within  the  limits  of  this  municipality,  un- 
less by  permit  of  the  board  of  health  or  health  officer, 
3arry  or  remove  from  one  building  to  another  any 
patient  affected  with  any  contagious  or  infectious  dis- 
ease. Nor  shall  any  person,  by  any  exposure  of  any  in- 
dividual so  affected,  or  of  the  body  of  such  individual 
or  of  any  article  capable  of  conveying  contagion  or  in- 
fection, or  by  any  negligent  act  connected  with  the  care 
or  custody  thereof,  or  by  a  needless  exposure  of  him- 


120  PUBLIC   HEAXTH   MANUAL 

self  or  herself,  cause  or  contribute  to  the  spread  of  dis- 
ease from  any  such  individual  or  dead  body. 

And  any  person  who  shall  neglect  or  refuse  to  obey 
any  of  the   provisions   of  this  section  shall  be  subject 

to   a   penalty   of    for   each   oflFense   and   for 

each    day's   continuance   or   repetition   of   the   offense. 

§  19.  School  and  library  books.— School  books  or 
books  from  a  public  or  circulating  library  shall  not  be 
taken  into  the  house  where  any  of  the  following  dis- 
eases shall  exist,  or  where  the  same  has  recently  existed, 
unless  the  house  has  been  thoroughly  disinfected  under 
the  direction  of  the  board  of  health  or  its  health  officer : 
Anterior  poliomyelitis,  bubonic  plague,  cerebrospinal 
meningitis,  cholera,  diphtheria,  leprosy,  measles,  scarlet 
fever,  smallpox,  typhoid,  typhus  or  yellow  fever.  In  case 
school  or  library  books  have  been  taken  into  such  house 
they  shall  not  be  returned  to  circulation  but  destroyed 
or  disinfected  to  the  satisfaction  of  the  health  officer  of 
the  municipality. 

§  20.  Spitting.— Spitting  upon  the  sidewalk  or  cross- 
walk of  any  public  street,  avenue,  park,  public  square, 

or   place,    in    the    village   of    ,    or    upon 

the  floor  of  any  hall  in  any  tenement-house  which  is 
used  in  common  by  the  tenants  thereof,  or  upon  the' 
floor  of  any  hall  or  lodging-house  which  is  used  in  com- 
mon by  the  guests  thereof,  or  upon  the  floor  of  any 
theatre,  schoolhouse,  church,  store,  factory,  or  any 
building  which  is  used  in  common  by  the  public,  or  upon 
the  floor  of  any  depot  or  station,  or  upon  the  floor  of 
any   railroad   car  or  other  public  conveyance,   or  upon 


SANITAKY   EEGUXATIO:!?S  121 


;he  station  platform  of  any  railroad  or  other  common 
;arrier,  is  hereby  forbidden. 

The  corporations  or  persons  owning  or  having  the 
nanagement  or  control  of  any  such  building,  store, 
"actory,  railroad  car  or  other  conveyance,  or  any  depot 
)r  station,  station  platform  or  common  carrier,  are 
lereby  required  to  keep  permanently  posted  in  each  of 
jaid  places  a  sufficient  number  of  notices  forbidding  spit- 
Ling  upon  the  floors,  and  calling  attention  to  the  pro- 
nsions  of  this  section. 

The  corporations  or  persons  owning  or  having  the  con- 
:rol  or  management  of  such  buildings,  stores,  factories, 
iepots,  stations,  station  platforms  or  other  common  car- 
riers are  hereby  required  to  provide  sufficient  and  proper 
receptacles  for  expectoration,  and  also  to  provide  for  the 
3leansing  and  disinfection  of  said  receptacles  at  least 
Dnce  in  every  twenty-four  hours. 

§  21.  Funerals  and  infectious  diseases. —  There  shall 
not  be  a  public  or  church  funeral  of  any  person  who 
has  died  from  any  of  the  following  diseases:  Anterior 
poliomyelitis,  bubonic  plague,  cerebrospinal  meningitis, 
cholera,  diphtheria,  leprosy,  measles,  scarlet  fever, 
smallpox,  typhus  fever  or  yellow  fever  without  the 
written  permit  of  the  health  officer  of  the  municipality. 
In  every  event  the  family  of  the  deceased  shall  limit 
the  attendance  to  as  few  as  possible,  and  shall  take 
such  precautions  as  the  board  of  health  or  health  officer 
may  direct  to  prevent  the  exposure  of  other  people  to 
contagion  or  infection. 

§  22.  Infectious    diseases    of    animals.— Any    person 
owning  or  having  the  care  of  any  animal  which  he  shall 


122  PUBLIC  HEAITH  MANUAL 

know  or  suspect  is  affected  with  glanders,  anthrax,  c 
any  other  contagious  or  infectious  disease,  dangerous  t 
the  public  health,  shall  immediately  isolate  such  anim^ 
from  other  animals,  and  shall  at  once  give  notice  theret 
to  the  health  officer  or  board  of  health  of  the  Iocs 
tion  of  such  animal  and  the  disease  from  which  it 
suffering. 

And  no  person  having  the  care  or  custody  of,  or  owi 
ing  any  animal  affected  with  any  such  disease,  sha 
lead,  drive  or  permit  such  animal  to  go  on  or  over  aD 
public  grounds,  uninclosed  land,  or  on  any  street,  publ: 
highway,  lane  or  alley;  nor  permit  it  to  drink  at  an 
public  watering  trough,  pail  or  spring;  nor  to  keep  sue 
diseased  animal  in  any  inclosure  in  or  from  which  sue 
diseased  animal  may  come  in  contact  with,  or  clos 
proximity  to,  any  animal  not  affected  with  such  dis 
ease.  And  an  animal  will  be  deemed  as  suspected  whe' 
it  has  stood  in  the  stable  with  or  been  in  contact  witl 
an  animal  known  to  have  any  of  said  communicab] 
diseases;  or  if  placed  in  a  stable,  yard  or  other  inclos 
ure  where  such  diseased  animals  have  recently  bee 
kept. 

^'^Tienever  an  animal  infected  with  any  of  the  diseast 
herein  named  shall  die,  or  shall  be  killed  the  body  ( 
such  animal  shall  be  immediately  burned.  Xo  po- 
mortem  examination  of  the  carcass  should  be  made,  ex 
cept  under  the  immediate  supervision  of  a  health  office 
or   sanitary  inspector. 

All  bedding,  litter,  excrement,  etc.,  that  have  accumi 
lated  about  such  animal,  together  with  all  blood  or  oth: 
fluid  elements  that  have  escaped  from  it  shall  be  burnet 
Dirt  floors  of  stables  wherein  such  animal  has  been  kej 
shall  be  removed  to  the  depth  of  four  inches  and  burner 


SANTTABY  BEGUXATIONS  123 

Everything  about  the  stable,  combs,  brushes,  or  any 
post  or  fence  where  it  has  stood,  and  every  part  of 
larness  or  wagon  used  with  such  animal,  and  the  stable 
vhere  it  has  been  kept,  shall  be  thoroughly  disinfected, 
inder  the  direction  of  a  duly  qualified  veterinary  sur- 
geon, or  the  health  officer. 

Whenever  the  owner  or  person  having  charge  of  an 
mimal  declared  by  the  stat«  veterinary  surgeon,  or  other 
authorized  person,  to  have  glanders  shall  refuse  to 
illow  the  destruction  of  such  animal,  the  premises 
svhereon  such  animal  is  kept  shall  be  quarantined 
until  such  animal  is  destroyed  and  the  premises 
thoroughly  disinfected. 

Any  violation  of  this  ordinance  shall  subject  the 
jffending  party  to  a  penalty  of for  each  offense. 

The  quarantine  shall  be  construed  to  mean  the  perfect 
isolation  of  all  diseased  or  suspected  animals  from  con- 
tact with  healthy  animals,  as  well  as  the  exclusion  of 
such  healthy  animals  from  the  yards,  stables,  enclosures 
or  grounds  wherever  said  suspected  or  diseased  animals 
are  or  have  been  kept. 

§  23.  Births. —  Every  physician  or  midwife  attending 
at  the  birth  of  a  child,  and  no  physician  or  midwife 
being  in  attendance,  the  parent  or  custodian  of  a  child 
shall  cause  a  certificate  of  such  birth  to  be  returned 
within  thirty-six  hours  thereafter  to  the  local  board  of 
health  or  person  designated  by  it  to  receive  the  same, 
which  shall  be  attested  by  the  physician  or  midwife,  if 
any  in  attendance,  and  no  physician  or  midwife  being  in 
attendance,  by  the  parent  or  custodian  of  a  child  born. 


124  PUBLIC   HEALTH    MANUAL 

Any  violation  of  this  ordinance  shall  subject  tht! 
offending  party  to  a  penalty  of for  each  offense.] 

§  24.  Deaths.— It  shall  be  the  duty  of  the  physiciam 
last  in  attendance  upon  any  person  who  may  die  tc 
fill  out  a  certificate  of  the  death  and  the  probable  cause 
and  duly  certify  to  same  and  deliver  the  certificate  tc 
the  loeal  registrar  of  vital  statistics  within  twenty-fom 
hours  after  the  death  occurs.  In  case  an  inquest  is  re- 
quired by  law,  the  coroner  or  the  coroner's  physician  shalli 
fill  out  the  said  certificate ;  and  if  no  inquest  is  required 
and  no  physician  was  in  attendance  at  the  time  of  death 
or  immediately  prior  thereto,  the  health  officer  of  the 
municipality  or  his  medical  assistant  shall  fill  out  and 
file  the  said  certificate.  i 

Any  violation  of  this  ordinance  shall  subject  the^ 
offending  party  to  a  penalty  of for  each  offense. 

§  25.  Burial  and  burial  permits. —  Every  undertaker, 
sexton  or  other  person  having  charge  of  any  corpse  shall 
procure  a  burial  permit  from  the  loeal  registrar  with 
whom  the  certificate  of  death  has  been  filed,  or  thei 
health  officer  of  the  town  or  municipality,  and  there 
shall  be  no  burial  or  removal  of  a  corpse  until  a  cer- 
tificate of  death  has  been  filed  as  required  by  law  and 
a  burial  or  transit  permit  issued. 

Any    violation    of    this    ordinance    shall    subject    the 

offending  party  to  a  penalty  of for  each  offense.; 

I 

§  26.  Sextons,  cemetery  keepers,  etc. —  Every  person 
who  acts  as  a  sexton,  or  undertaker,  or  cemetery  keeper, 
within  the  limits  of  this  municipality,  or  has  the  charge 


I 


SANITARY   REGULATIONS  125 


r  care  of  any  tomb,  vault,  burying  ground  or  other 
lace  for  the  reception  of  the  dead,  or  where  the  bodies 
f  any  human  beings  are  deposited,  shall  so  conduct  his 
usiness  and  so  care  for  any  such  place  abore  named, 
s  to  avoid  detriment  or  danger  to  public  health;  and 
very  persbn  undertaking  preparation  for  the  burial  of 

body  dead  from  contagious  or  infectious  disease  as 
ereinbefore  enumerated  shall  adopt  such  precautions  as 
he  board  of  health  may  prescribe  to  prevent  the  spread 
f  such  disease. 

Any  violation  of  this  ordinance  shall  subject  the 
lending  party  to  a  penalty  of for  each  offense. 

i 

§  27.  Duties  and  powers  of  health  officer. —  1.  The 
ealth  officer  is  directed  and  empowered  to  execute  and 
Qforce  all  sanitary  regulations  of  general  or  special 
ature  now  or  hereafter  adopted  or  published  by  this 
oard. 

2.  To  enter  upon  or  within  any  premises,  lots,  yards 
liildings,  or  houses,  at  all  times  to  investigate  any  con- 
itions  thereon  or  therein,  which  he  might  believe  to  be 
angerous  to  public  health,  and  when  such  is  foimd,  to 
rder  and  direct  the  prompt  removal  or  abatement  of 
le  same. 

3.  To  examine  into  the  nature  of  complaints,  made  by 
ay  inhabitant  of  this  municipality,  concerning  sources 
r  conditions  dangerous  to  public  health,  and  when  by 
ivestigation  he  shall  find  such  conditions  to  be  a 
lenace  to  health  he  shall  forthwith  proceed  to  have  the 
ime  removed  or  abated. 

4.  Whenever  in  his  judgment  danger  to  public  health 
aall   arise,   requiring   special    regulation,   he   shall    im- 


126  PUBLIC   HEALTH    MANUAL 

mediately  notify  the  president  of  the  board  of  healtl 
of  such  danger,  who  shall  thereupon  convene  the  boarc 
and  take  such  action  as  may  l)e  necessary  to  properly 
meet  the  condition. 

5.  To  preserve  an  accurate  record  of  his  official  ac 
tions,  and  to  report  the  same  to  the  board  of  healti 
on  the  first  Monday  of  each  month  or  at  such  othe; 
times  as  may  be  requested  by  the  board. 

6.  To  meet  with  the  board  of  health,  when  requested 
and  to  recommend  to  the  board  the  adoption  of  sucl 
sanitary  measures  as  in  his  judgment  would  prove  mos" 
conducive  to  the  health  of  the  people  of  this  munici- 
pality. 

7.  To  attend  the  Annual  Conferences  of  Health  OflBcers , 
held  under  the  auspices  of  the  State  Department  o: 
Health,  to  favor  and  assist  organized  efforts  to  promott 
and  popularize  advanced  ideas  of  sanitation,  and,  to  th< 
best  of  his  ability,  to  keep  himself  well  informed  or 
matters  pertaining  to  public  health. 

8.  To  perform  such  duties  as  are  laid  upon  th( 
health  officer  by  section  319  of  the  tuberculosis  law;  tC' 
maintain  an  adequate  supply  of  tetanus  and  diphtheria 
antitoxin  culture  tubes,  sputum  jars,  etc.,  furnished  bj 
the  State  Department  of  Health;  and  to  properly  dis- 
tribute such  circulars  and  all  printed  matter  relating  tc 
communicable  diseases,  etc.,  as  are  provided  for  thai 
purpose  by  the  State  Department  of  Health. 

9.  To  ascertain  all  violations  of  section  76  of  the 
Public  Health  Law  relating  to  the  discharge  of  sewage 
and  other  waste  matter  into  the  streams  flowing 
through  this  municipality,  and  report  same  to  the  local 
board  of  health,  so  that  the  board  may  enforce  coin- 
pliance  with  said  act  as  required  by  law. 


SANITARY   EEGULATIOXS  127 

P 

§  28.  Penalties. —  Every  person  wlio  wilfully  violates 
r  refuses  to  comply  with  or  who  resists  any  ordinance, 
rder,  regulation  or  resolution  of  the  board  of  health  of 
lis  municipality  will  be  liable  to  arrest  and  the  pen- 
Ity  prescribed  by  such  ordinances,  as  provided  for  by 
iction  21  of  the  Public  Health  Law,  prescribing  the 
gneral  powers  and  duties  of  local  boards  of  health,  of 
-^hich  notice  must  be  taken. 

Note. —  Prior  to  January  1,  1908,  local  boards  of 
ealth  were  required  to  see  that  all  marriages  were 
roperly  recorded,  but  under  the  provisions  of  the  Mar- 
iage  License  Law  such  duties  are  now  placed  on  the 
Dwn  or  city  clerks. 


128  PUBLIC   HEAX-TH    MANUAL 


IXSTRUCTIONS  TO  HEALTH  OFFICERS 

Executive  officer. —  Local  boards  of  health  are  required 
by  the  Public  Health  Law  to  make  and  publish  sucl 
orders  and  regulations  deemed  necessary  and  proper  foi 
the  preservation  of  life  and  health,  and  the  executior 
and  enforcement  of  the  general  public  health  laws 
The  same  section  makes  the  health  officer  the  chie: 
executive  officer  of  the  board  of  health  to  carry  intc 
effect  its  orders.  His  duties  and  powers  are  to  be  pre 
scribed  by  the  board,  and  at  the  same  time  he  is  its 
medical  adviser,  and  carries  on  its  work,  not  otherwise 
delegated.  A  health  officer  must  be  a  resident  of  th( 
municipality  in  which  he  serves  or  of  the  town  adjoin- 
ing it.  His  compensation  is  fixed  by  the  board,  whicl 
must  also  allow  his  actual  and  reasonable  expenses  ir 
attending  the  Annual  Conference  of  Health  Officers  oj 
the  State,  and  in  its  discretion  may  allow  an  extra  com- 
pensation beyond  his  fixed  allowance,  when  for  anj 
reason  his  services  are  extraordinary. 

In  case  any  one  fails  to  observe  the  orders  and  regu 
lations  of  the  board,  or  the  legitimate  requirements  o; 
its  executive  officer,  such  person  should  be  cited  by  hin 
to  appear  before  the  board  to  show  cause  why  he  has 
so  failed  and  the  penalty  fixed  for  violation  thereof  nol 
imposed. 

Burial  permits. —  The  health  officer  (with  the  loca 
registrar  of  vital  statistics)  is  designated  to  grant  buria 
and  transit  permits.  If  transportation  is  by  railroac 
or  passenger  steamboat,  it  must  be  required  that  th( 
corpse  be  enclosed  in  a  hermetically  sealed  casket,  il 
death  was  from  a  communicable  disease.  The  rules  foi 
transportation  of  the  dead  can  be  found  in  this  manual 
The  health  officer  and  registrar  of  vital  statistics  should 


IXSTBUCTIOXS    TO   HEAXTH   OFTICEES  129 

see  that  undertakers  strictly  comply  ^ith  the  la"vt  re- 
quiring them  to  procure  a  burial  permit  before  burial, 
which  is  to  be  issued  only  on  a  properly  filled  out  cer- 
tificate of  death. 

Health  ofiicers  should  see  that  the  certified  cause  oi 
death  is  properly  and  fully  supplied^  and  that  indefinite 
terms,  by  which  the  cause  is  ill  defined,  are  not  used. 
If  no  physician  has  been  in  attendance,  and  the  case  is 
not  one  for  a  coroner's  inquest,  the  certificate  of  death 
should  be  filled  out  and  filed  by  the  health  officer, 
i 

Communicable  diseases  to  be  reported. —  Every  phy- 
sician is  required  by  law  to  report  at  once  all  cases  of 
communicable  disease  in  his  care  to  the  health  officer, 
and  if  no  physician  is  in  attendance,  the  duty  is  im- 
posed on  the  householder  where  the  case  occurs. 

The  diseases  to  be  so  reported  have,  under  the  law, 
been  designated  by  the  State  Commissioner  of  Health  as 
poliomyelitis,  anthrax,  huhonic  plague,  cancer,  cerehro- 
spinal  meningitis,  cholera,  diphtheria,  rahies,  leprosy, 
measles,  ophthalmia  neonatorum,  pellagra,  pneumonia, 
scarlet  fever,  smallpox,  tetanus,  pulmonary  or  laryngeal 
tuherculosis.  typhoid  fever,  typhus  fever,  ichooping  cough, 
chickenpox,  and  yelloio  fever. 

The  occiu'rence  of  these  diseases  should  be  reported 
immediately  to  the  State  Department  of  Health,  by  the 
health  officer,  using  the  cards  furnished  by  the  depart- 
ment on  which  to  render  all  of  these  reports. 

It  is  particularly  important  not  only  that  all  com- 
municable diseases  be  immediately  reported  to  the  de- 
i  partment,  but  that  most  vigilant  and  energetic  measures 
be  instituted  to  so  handle  the  first  case  appearing  in 
any  municipality  as  to  reduce  to  a  minimum  the  danger 
of  further  outbreak. 


130  PUBLIC   HEALTH   MANUAL 

Health  officers  should  co-operate"  with  the  attending 
physician  in  a  detailed  investigation  of  the  source  of 
every  outbreak  of  every  communicable  disease,  never  for- 
getting that  the  most  effective  results  are  obtainable 
by  the  successful  management  of  tJw  first  case. 

In  typhoid  fever,  for  example,  he  ought  to  personally 
ascertain  all  the  facts  called  for  on  the  report  card, 
determining,  if  possible,  the  origin  of  the  case,  and  ii 
discovered  remove  it  as  promptly  and  effectually  as  po? 
sible.  The  existence  of  this  disease  in  his  municipality 
should  be  a  matter  of  concern  to  every  health  officer 
Suggestions  regarding  investigation  of  this  and  othei 
communicable  diseases  can  be  found  under  their  respect- 
ive chapters  in  this  manual. 

A  special  report  of  each  case  of  measles,  when  it  i; 
epidemic,  need  not  be  made,  but  the  Department  should 
be  kept  informed  of  the  progress  of  the  epidemic  and 
report  all  cases  of  this  and  other  diseases  on  the 
monthly  card. 

As  to  quarantine. —  It  is  made  the  duty  of  the  locaJ 
board  of  health  to  guard  its  municipality  from  the  in 
troduction  and  spread  of  communicable  diseases. 

The  health  officer  has  therefore  authority  to  enforc 
this  law  by  isolating  the  sick,  excluding  suspected  per 
sons,  or  by  quarantining  households  and  disinfecting 
premises,  buildings  or  other  infected  objects  or  prop 
erties. 

He  is  the  one  who  must  determine  when  quarantin 
is  necessary,  and  to  establish  and  maintain  it,  with  th 
assistance  of  the  board  of  health. 

The  subsequent  disinfection,  such  as  the  case  calls  foi 
is  also  a  part  of  his  responsibility,  and  he  should  full 
satisfy  himself  that  it  is  well  and  properly  done.  Fum' 
gation,  when  necessary,  ought  to  be  a  public  charge,  fo 
the  public  health  authorities  are  made  responsible  fo 


m  nsrSTETJCTTONS   TO   HEAXTH  OFFICEES  131 

its  being  done;  the  mimicipality  should  furnish  the 
health  officer  with  everything  necessary  to  do  thorough 
disinfection,  and  par  him  for  doing  it,  as  private 
parties  are  not  likely  to  do  it  effectively,  and  the  pub- 
lic is  more  interested  in  its  being  done  properly  than 
the  persons,  who  for  the  protection  of  the  public  have 
borne  the  burden  of  quarantine. 

Sanitary  regulations.—  The  board  of  health  is  author- 
ized to  make  and  publish  orders  and  regulations  for  the 
preservation  of  life  and  health  and  the  enforcement  of 
;he  general  public  health  laws,  and  to  prescribe  and 
mpose  penalties  for  their  violation. 

The  State  Department  of  Health  has  prepared  suit- 
ible  regulations  (see  page  106)  as  a  guide  to  the  local 
)oards  of  health,  and  each  board  should  make  and  pub- 
ish  such  regulations,  fixing  a  definite  penalty  for  the 
'iolation  or  failure  to  comply  with  each. 

This  will  facilitate  the  work  of  the  health  officer. 

As  to  nuisances.— The  definition  of  nuisances,  so  far 
IS  it  is  possible  to  frame  one,  is  to  be  found  in  the 
■janitary  Regulations,  and  some  of  them  are  further 
esignated  in  sections  of  the  law  and  in  the  Penal  Law. 

To  determine  whether  nuisances  exist  and  how  to 
bate  them  is  largely  the  work  of  a  health  officer. 
Vhen  one  is  found  to  exist  he  may  serve  a  formal  order 
n  the  person  maintaining  it,  requiring  the  same  to  be 
bated  within  a  specified  period,  and  in  case  of  failure 
D  comply  with  such  order,  the  property  may  be  entered 
pon  and  such  work  done  as  may  be  found  necessary  to 
jbate  said  nuisance.  The  cost  for  such  work  shall  be 
:  claim  against  the  person  who  was  found  responsible 
j^r  the  existence  of  the  nuisance  so  abated.  Or  a  per- 
'Dn  creating  or  maintaining  a  nuisance  may  be  cited 
.efore  the  board  of  health  for  its  action.  The  course 
;f  procedure  will  depend  on  conditions  of  the  case,  and 


132  PTJBLIO  HEALTH   MANUAL 

often  the  result  desired  may  be  secured  by  personal 
appeal.  In  the  investigation  of  nuisances  tlie  health 
officer  has  authority,  if  delegated  to  him  by  the  board 
of  health,  to  enter  upon  premises  where  conditions 
dangerous  to  health  are  known  or  believed  to  exist, 
and  to  enforce  thereon  or  therein  published  or  adopted 
orders  of  the  board,  or  if  a  special  regulation  is  neces 
sary,  to  report  the  same  to  the  board.  He  should  keep 
a  complete  record  of  his  actions  and  submit  a  report  oi 
the  same  to  the  board  of  health  at  such  times  as  may 
be  required,  either  by  regulation  or  request. 

Antitoxin. —  The  State  Department  of  Health  fur- 
nishes both  diphtheria  and  tetanus  antitoxin  for  tht 
treatment  and  immunization  of  inmates  of  State  institu 
tions,  inmates  of  other  charitable  institutions  of  th( 
State,  and  persons  unable  to  purchase  it  in  needec 
quantities.  l| 

Every  health  officer   should  have  on  hand  a  suitabLI 
supply  of  each  kind  of  antitoxin,  and  make  certain  tha 
he  is  always  ready  to  meet  an  emergency  request  for  itij 
employment. 

The  State  Department  of  Health  emphatically  recoml 
mends  the  free  and  early  use  of  antitoxin,  both  diphj 
theria  and  tetanus,  and  urges  that,  in  an  emergency 
no  question  be  raised  as  to  the  ability  of  the  person  o 
family  to  pay  for  it.  No  doubtful  case  of  possible  in 
fection  with  tetanus  should  be  allowed  to  go  unpro 
tected  by  an  immunizing  dose  of  antitoxin.  In  ever; 
question  of  doubt  do  not  hesitate  to  give  the  patien 
the  benefit,  as  it  is  the  health  of  the  people  we  mus 
conserve. 

Printed  information  as  to  ordering,  administering  an 
keeping  antitoxin  accompanies  each  package  sent  to  tl^ 
health  officers. 


r^^STEUCTIo^'s  to  health  oiticees  133 

I 

Culture  tubes. —  Culture  tubes  for  sending  specimens 
from  suspected  diphtheria  patients  for  examination,  or 
for  determining  when  to  suspend  quarantine^  are  fur- 
nished by  the  State  Department  of  Health,  and  cultures 
are  made  and  examined  from  such  specimens  "without 
charge. 

Tuberculosis. —  Health  officers  are  asked  not  only  to 
comply  with  the  legal  requirements  now  in  force,  but  to 
do  all  they  can  to  help  on  the  great  work  now  in 
progress  to  control  this  important  disease. 

Suggestions  will  be  found  in  the  circular  on  tubercu- 
losis. The  duty  of  enforcing  precautions  to  be  observed 
by  tuberculous  patients  is  placed  strictly  on  the  health 
officer.     See  sections  320-328  of  the  Public  Health  Law. 

It  is  made  the  duty  of  health  officers  under  the  law 
to  cause  to  be  made  a  microscopical  examination  of 
sputum  from  a  person  suspected  of  having  tuberculosis 
on  the  request  of  any  physician  or  the  authorities  of  a 
hospital  or  dispensary,  free  of  charge,  and  to  report 
the  results  promptly  to  those  making  the  application, 

Sputum  jars  for  sending  specimens,  from  suspecteil 
cases,  are  furnished  by  this  Department  and  examina- 
tions are  made  free  of  charore. 

Laboratory  examinations. —  The  State  Department  of 
Health  will,  at  the  request  of  a  health  officer,  make  a 
laboratory  diagnostic  test,  in  a  suspected  case  of  diph- 
theria, tuberculosis,  typhoid  fever  or  cerebrospinal 
meningitis. 

Widal  outfits  are  supplied  for  diagnostic  piu'poses  in 
typhoid  fever,  and  in  the  investigation  into  the  cause 
of  this  disease  the  Department  is  prepared  to  examine 
: suspected  water.    (See  circular  on  Water  Analysis.) 

Spinal  fluid  in  suspected  cases  of  cerebrospinal  menin- 
gitis will  also  be  tested  as  to  diagnosis  at  the  State 
Hygienic  Laboratory. 


134  PUBLIC   HEALTH    MANUAL 

Health  officers  should  avail  themselves  of  these  valu- 
able aids  for  diagnostic  purposes,  and  should  extend  the 
same  privilege  to  the  physicians  of  their  locality. 

Ophthalmia  neonatorum. — All  physicians  of  the  State 
have  been  informed  of  the  work  done  by  the  Department 
to  suppress  ophthalmia  neonatorum.  Health  officers 
should  maintain  an  ample  supply  of  the  outfits  fur- 
nished by  the  Department  and  make  certain  that  the 
same  are  distributed  to  the  physicians  needing  them. 

The  health  officer  should  also  endeavor  to  encourage 
the  physicians  of  his  municipality  to  habitually  employ; 
either  the  prophylaxis  furnished  by  the  State  or  som€ 
other  equally  efficient  measure  to  protect  the  eyes  of 
the  new-born  from  blindness. 

The  health  officer  and  the  public  school. —  The  health 
officer  of  any  municipality  can  and  should  render  valu- 
able service  to  the  educational  authorities  in  safeguard 
ing  the  health  of  the  children. 

Testing  of  eyes  and  ears. — With  the  approval  of  the 
State  Department  of  Education,  this  Department  sendj 
to  the  presidents  of  boards  of  education  in  countrj; 
towns  and  villages  material  to  be  used  by  the  teachers 
in  examining  the  eyes  and  ears  of  the  school  children 
Upon  request  this  material  may  be  sent  direct  to  tht 
teacher.  These  examinations,  while  necessarily  imper 
fectly  done,  in  most  instances  discover  such  functiona 
defects  of  these  senses  as  call  for  effective  remedia' 
attention. 

The  health  officer  can  often  materially  assist  in  thi: 
work  and  do  much  to  popularize  it  and  increase  it: 
efficiency. 


IXSTEUCTIOXS    TO    HEAXTH   OFFICEES  135 

Communicable  diseases  in  schools. —  Wlien  communi- 
cable diseases  develop  among  the  pupils  every  care 
should  be  taken  to  exclude  those  infected. 

Vigilant  energetic  co-operation  between  health  oflScer, 
teachers^  parents  and  the  local  physicians  ought  to  sup- 
press an  outbreak  of  any  communicable  disease  in  its 
incipiency,  and  avoid  the  heroic  measure  of  closing  the 
school,  always  a  serious  matter  in  school  work. 

Not  infrequently  scabies,  pediculosis,  contagious  im- 
petigo and  other  parasitic  diseases  develop  among 
school  children.  It  is  needless  to  say  that  children  so 
affected  should  be  excluded  from  school,  and  this,  by 
the  advice  of  the  health  officer,  ought  to  be  done  by 
.the  school  officers.  Health  officers  may  hold  that  these 
diseases  are  a  menace  to  public  health  and  advise  action 
accordingly. 

The  above  diseases  when  properly  treated  require  but 
a  short  time  to  effect  a  cure,  hence  the  loss  of  time  from 
school  should  be  brief. 

Those  having  acute  conjunctivitis,  or  trachoma,  should 
also  be  excluded  unless  they  receive  proper  treatment. 

The  sanitary  condition  of  school  buildings  and  of 
school  children  is  a  legitimate  matter  of  investigation 
and  concern  to  every  board  of  health  and  every  health 
officer,  and  should  always  be  borne  in  mind. 

Vaccination  of  school  children. —  It  is  made  the  duty 
of  school  officers  to  refuse  admittance  to  the  public 
schools  of  all  unvaccinated  persons  (section  210,  Public 
Health  Law),  and  to  provide  vaccination  for  those  who 
are  unable  to  pay  for  it.  It  is  urged  on  health  officers 
to  use  every  effort  to  secure  the  enforcement  of  this  law, 
and  the  board  of  health  should  use  all  legitimate  means 
within  its  powers  to  effect  it  in  the  interest  of  the 
public  health. 


136  PUBLIC   HEALTH    MANUAL 

When  parents  refuse  to  have  a  child  vaccinated,  it  is 
the  duty  of  the  school  authorities  to  exclude  that  child 
from  the  public  schools.  It  is  also  the  duty  of  the  same 
authorities  to  see  that  the  child  is  properly  educated, 
and  if  the  parents  do  not  make  adequate  provision  for 
the  education  of  the  child,  the  educational  authorities 
must  proceed  against  them  as  the  Education  Law  pro- 
vides. 

Tlie  law  (section  24)  requires  that  boards  of  healtli 
shall  provide  supplies  of  vaccine  virus  at  stated  intervals 
and  at  all  times  furnish  vaccination  to  all  persons  in 
need  of  it. 

Treatment  for  rabies  at  Pasteur  Institute. —  Section 
340  of  article  17  of  the  Public  Health  Law  provides 
that  persons  who  have  been  certified  by  registered  phy- 
sicians to  have  been  bitten  by  rabid  animals  or  other- 
wise put  in  danger  of  infection  of  rabies,  may  be  sent 
to  the  Pasteur  Institute  in  the  city  of  New  York  by 
overseers  of  the  poor  or  other  officers  having  charge  of 
the  dispensation  of  public  charity  in  the  several 
coimties  of  the  State. 

Section  341  provides  that  the  transportation  of  such 
persons  shall  be  a  charge  upon  the  count}",  the  sus- 
tenance and  preventive  treatment  to  be  provided  by  the 
Pasteur  Institute. 

Section  342  provides  that  charges  for  the  services  of 
the  Institute  shall  be  paid  as  provided  by  section  42  of 
the  Poor  Law,  at  a  rate  not  exceeding  $100  a  person. 

It  is  plainly  the  duty  of  every  health  officer  to  so 
acquaint  any  person  bitten  by  a  rabid  animal  with  the 
provisions  of  this  law  that  no  delay  may  arise  in  the 
administration  of  proper  treatment. 

Health  officers  to  care  for  insane  patients. —  The  at- 
tention of  the   health   officers   of   the   State  is   directed 


I 


INSTEUCTIOXS    TO    HEALTH   OFFICEES  137 


to  chapt-er  608  of  the  Laws  of  1910,  amending  the  In- 
sanity Law,  relative  to  the  care  and  treatment  of  insane 
persons,  in  effect  October  1,  1910. 

Section  87  provides  that  the  poor  officers  or  author- 
ities, except  in  the  city  of  Xew  York  and  in  the  county 
of  Albany,  shall  notify  the  health  officer  of  the  town, 
city  or  village  of  any  poor  or  indigent  insane  or  ap- 
parently insane  person  within  such  municipality  whom 
they  know  to  be  in  need  of  relief.  When  so  notified,  or 
when  otherwise  informed  of  such  fact,  the  health  officer 
shall  see  that  proceedings  are  taken  for  the  determina- 
tion of  his  mental  condition  and  for  his  commitment  to 
a  State  hospital.  The  health  officer  may  direct  the 
proper  poor  official  to  make  an  application  for  such  com- 
mitment and,  if  a  qualified  medical  examiner,  may  join 
in  making  the  required  certificate  of  lunacy. 

WTien  an  order  of  commitment  has  been  made  the 
health  officer  shall  see  that  such  insane  person  is  trans- 
ferred to  the  proper  institution  and  that  he  is  in  a 
state  of  bodily  cleanliness  and  comfortably  clothed  in 
accordance  with  the  regulations  prescribed  by  the  Com- 
mission. 

Pending  the  determination  of  the  question  of  his 
sanity  and  until  his  transfer  to  a  State  hospital,  or  some 
other  proper  State  institution,  the  health  officer  shall 
see  that  such  person  is  cared  for  in  a  place  suitable  for 
the  comfortable,  safe  and  humane  confinement  of  such 
person. 

The  compensation  or  fees  and  expenses  of  health 
officers  for  duties  performed  in  respect  to  the  examina- 
tion, confinement,  care  and  treatment  of  the  insane  as 
required  by  this  act  shall  in  each  case  be  determined 
and  allowed  by  the  judge  or  justice  allowing  the  com- 
mitment or  hearing  the  application,  and  shall  be  a 
charge  upon  the  town,  city  or  county  in  which  such 
persons  reside  or  mav  be. 


138  PUBLIC   HEALTH    MANUAL 

Tlie  State  Commission  in  Lunacy  has  prepared  and 
distributed  to  the  health  officers  of  the  State  a  valuable 
circular  on  "  Duties  of  Poor  Law  Officials  and  of  Health 
Officers  in  the  Care  of  the  Insane  Pending  Commit- 
ment." This  circular  will  be  found  of  much  assistance 
to  the  health  officer  in  his  special  duties  to  the  insane 
patient.  Extra  copies  of  it  can  be  promptly  obtained 
by  addressing  the  Commission  in  Lunacy,  Albany,  N.  Y. 
It  is  the  duty  of  the  health  officer  to  fully  familiarize 
himself  with  the  provisions  of  this  law,  and  to  comply 
with  its  requirements. 

Supplies. —  The  State  Department  of  Health  furnishes 
on  application,  which  should  be  made  on  the  formal 
blanks,  to  health  officers  as  needed,  supplies  of  diph- 
theria and  tetanus  antitoxin,  culture  tubes  for  diph- 
theria, sputum  jars,  Widal  outfits,  ophthalmia  neona- 
torum outfits,  circulars  of  instruction  to  health  officers 
and  to  the  public  on  communicable  diseases,  disinfection 
and  disinfectants,  vaccination  and  many  other  subjects. 

In  specifying  the  kind  and  number  of  supplies  or  cir- 
culars wanted  reasonable  care  should  be  exercised.  It 
is  desirable  that  those  intended  for  popular  instruction 
be  circulated  where  they  will  be  most  effective.  Every 
health  officer  should  consider  it  one  of  his  paramount  j 
duties  to  keep  himself  well  supplied  with  the  above- 
mentioned  supplies  so  willingly  furnished  by  the  Depart- 
ment and  to  see  that  the  same  are  used  to  the  best  pos- 
sible advantage.  ^'\^ien  in  urgent  need  supplies  can  be 
ordered  by  telephone  or  telegraph. 


Purchase  of  supplies.—  The  following  supplies  not  fur- 
nished by  the  State  Department  of  Health  have  beer 
approved  by  the  Department  and  should  be  purchased 
by  the  local  municipality  and  kept  on  hand  for  use  at 
any  and  all  times.  It  should  be  the  duty  of  the  healtl: 
officer   to  make   certain  that  such   of   these  supplies  as 


INSTEUCnONS   TO   HEAITH   OFFICEES  139 

I  may  be  necessary  for  the  proper  performance  of  any  of 
I  his  duties  are  kept  constantly  on  hand  and  at  his  dis- 
posal :     Burial  permits,  transit  pennits  —  for  the  trans- 
iportation  of  a  corpse  by  railroad,  etc.;  complaint  of  a 
nuisance ;  notice  to  abate  nuisance ;  notice  of  hearing  on 
I  nuisance;  notice  of  imposition  of  fine;   permits  for  re- 
[moval  of  corpse;  tuberculosis  register  books  and  blanks; 
factory  certificates  and  blanks  for  employment  of  chil- 
dren;  supplemental  birth  reports  —  for  reporting  given 
name    of   children;    registers   for    recording   births   and 
I  deaths  in  local  health  bureau. 

EmplojTment  of  minors.— Section  70  of  article  6  of 
,the  Labor  Laws  of  the  fcitate  of  New  York  provides  that 
no  child  imder  the  age  of  fourteen  years  shall  be  em- 
ployed, permitted  or  suffered  to  work  in  or  in  connec- 
tion with  any  factory  in  this  State.  K"o  child  between 
the  ages  of  fourteen  and  sixteen  years  shall  be  so  em- 
ployed, permitted  or  suffered  to  work  unless  an  em- 
ployment certificate,  issued  as  provided  by  this  article, 
shall  have  been  theretofore  filed  in  the  office  of  the  em- 
ployer at  the  place  of  employment  of  such  child. 

Section  71  of  the  same  article  provides  that  such  cer- 
.tifieate  shall  be  issued  by  the  commissioner  of  health 
or  the  executive  officer  of  the  board  of  health  of  the 
city,  town  or  village  where  such  child  resides  or  is  to 
be  employed,  or  by  such  other  officer  thereof  as  may  be 
designated  by  such  board,  department  or  commissioner 
for  that  purpose,  upon  the  application  of  the  parent 
or  guardian  or  custodian  of  the  child  desiring  such 
employment.  Such  officer  shall  not  issue  such  certificate 
until  he  has  received,  examined,  approved  and  filed  the 
following  papers  duly  executed,  namely:  The  school 
record  of  such  child  pro-perly  filled  out  and  signed  as 
provided  in  this  article;  also,  evidence  of  age  showing 
that   the    child  is   fourteen   years  of   age  or  upwards. 


140  PUBLIC    HEALTH    MANUAL 

which  evidence  shall  consist  of  one  of  the  following  sub- 
divisions of  this  section  and  which  shall  be  required  in 
the  order  herein  designated,  as  follows:  Birth  certifi- 
cate; certificate  of  graduation;  passport  or  baptismal 
certificate;  other  documentary  evidence  concerning  the 
date  of  birth  and  age  of  the  child;  physician's  certifi- 
cate as  to  the  date  of  birth  of  child. 

Such  employment  certificate  shall  not  be  issued  until 
such  child  further  has  personally  appeared  before  and 
been  examined  by  the  oflicer  issuing  the  certificate,  and 
until  such  officer  shall,  after  making  such  examination, 
sign  and  file  in  his  office  a  statement  that  the  child 
can  read  and  legibly  write  simple  sentences  in  the  Eng- 
lish language  and  that  in  his  opinion  the  child  is  four- 
teen years  of  age  or  upwards  and  has  reached  the  nor- 
mal development  of  a  child  of  its  age,  and  is  in  sound 
health  and  is  physically  able  to  perform  the  work  which 
it  intends  to  do.  In  doubtful  cases  such  physical  fitness 
shall  be  determined  by  a  medical  officer  of  the  board  or 
department  of  health.  Every  such  employment  certifi- 
cate shall  be  signed,  in  the  presence  of  the  officer  issuing 
the  same,  by  the  child  in  whose  name  it  is  issued. 

The  municipality  should  procure  for  the  health  officei 
the  necessary  blanks  for  the  proper  execution  of  these 
certificates  of  employment. 

Report  of  infectious  or  contagious  diseases  in  domestic 
animals.— Section  90,  article  V,  chapter  1  of  the  Con- 
solidated Laws,  known  as  the  Agricultural  Law,  of  1909 
requires  that  the  local  boards  of  health  shall  notify  th< 
Commissioner    of    Agriculture    of    the    existence    of    in 
fectious     or     contagious     diseases     affecting     domesti« 
animals  in   the   districts   subject  to   their    jurisdiction 
As  the  executive  officer  of  such  boards  of  health,  it  li- 
the duty  of  the  health  officer  to  see  that  this  law  ii\ 
properly  complied  with. 

( 

i 


^  INSTBUCTIOXS   TO   HEAXTH  OFFICEKS  141 

Co-operation  of  State  Department  and  Health  Officers. 
—  It  is  the  earnest  desire  of  the  State  Commissioner  of 
Health  that  the  best  relations  should  exist  between  the 
Department  and  the  local  health  officers  both  in  their 
daily  duties  and  in  the  personal  contact  afforded  by 
the  Annual  Conference.  He  desires  to  be  kept  informed 
of  the  health  conditions  of  every  municipality,  and  is 
ready  and  anxious,  either  by  correspondence  or  expert 
advice,  to  lend  every  possible  assistance  to  any  health 
officer  or  board  of  health  within  the  State. 

Educational  efforts. —  Reforms  move  slowly,  the  leaders 
are  always  far  ahead  of  the  rank  and  file.  The  first 
great  step  in  the  promotion  of  the  public  health  is  the 
education  of  the  people.  The  health  officer  should  be 
the  local  leader  in  this  campaign  of  education. 

Use  the  newspaper.  Your  local  editor  will  be  glad  to 
give  you  the  necessary  space  and  will  welcome  and  sup- 
port your  effort.  Tell  the  people  in  elementary  lan- 
guage the  plain  facts  of  sanitary  science,  of  personal 
hygiene,  and  of  the  prevention  of  communicable  dis- 
eases. When  communicable  disease  is  epidemic  in  his 
or  a  neighboring  community,  the  citizens  should  be  noti- 
fied of  the  fact  through  the  newspapers  and  advised  how 
to  avoid  its  occurrence  in  their  own  households.  The 
Division  of  Publicity  and  Education  of  the  State  De- 
partment of  Health  will  be  glad  to  give  assistance  in 
preparing  copy  for  newspapers. 

Use  the  lecture  platform.  Give  illustrated  talks  in 
schools,  before  trades  unions,  or  other  bodies  of 
citizens.  The  State  Department  of  Health  has  prepared 
a  series  of  popular  lectures  and  will  send  the  text  and 
a  set  of  slides  for  illustrations,  with  which  information 
on  a  number  of  important  subjects  can  be  brought  in 
an  attractive  way  before  the  people. 


142  PUBLIC   HEALTH    MANUAL 

Use  the  Monthly  Bulletin  of  the  State  Department 
of  Health.  Read  it  yourself  to  keep  in  touch  with 
the  work  of  the  Department,  and  see  that  the  names  of 
the  physicians  in  your  community  and  others  who  are 
interested  in  public  health  work,  are  on  the  mailing  list. 
The  Bulletin  will  be  sent  free  to  all  who  care  to  ask 
for  it.  Health  officers  should  see  that  each  number  of 
the  Bulletin  is  preserved  so  that  there  may  always  be 
an  unbroken  file  in  the  possession  of  the  board  of  health 
for  reference,  and  as  a  record  of  vital  statistics. 

Use  the  circulars  issued  by  the  State  Department  of 
Health,  some  of  which  appear  in  this  Manual,  while  of 
others  for  popular  use  are  the  following:  On  Typhoid 
Fever,  Measles,  Whooping  Cough,  Scarlet  Fever,  Diph- 
theria, Smallpox.  Oplithalmia  Neonatorum,  in  English 
and  other  languages;  on  Tuberculosis  with  pocket  cards 
and  other  instructive  matter;  a  pamphlet  on  Vaccina- 
tion for  distribution  to  those  interested  for  or  against 
its  use,  and  a  leaflet  on  "  Flow  to  Care  for  Vaccination." 
Circulars  of  instruction  to  health  officers  and  registrars, 
and  on  Disinfection  and  Disinfectants  are  also  available. 


INSTRUCTIONS   TO  REGISTRAES  143 


_  INSTRUCTIONS  TO  REGISTRARS 

'*'  Local  boards  of  health  are  required  to  "  supervise 
and  make  complete  the  registration  of  all  births  and 
deaths/'  and  the  local  registrar  of  vital  statistics  is 
required  to  file  certificates  of  same  with  the  State 
Department  of  Health,  on  or  before  the  5th  of  each 
month.  (See  section  22  of  the  Public  Health  Law.) 
Local  boards  of  health  are  required  to  make  and  en- 
force regulations  requiring  the  prompt  reporting  of  all 
births  and  deaths  to  the  local  registrar' — births  to  be 
reported  within  36  hours,  and  deaths  within  24  hours 
after  the  event  takes  place.- 

If  each  local  board  would  adopt  such  regulations 
and  impose  the  fine  prescribed  upon  physicians  failing 
to  comply  with  the  registration  laws,  it  would  have 
little  difficulty  in  securing  complete  and  prompt  re- 
turns of  the  original  certificates  of  all  births  and 
deaths  occurring. 

It  is  the  duty  of  the  local  registrar  to  promptly 
notify  the  members  of  the  local  board  of  health  of 
the  failure  on  the  part  of  any  physician  to  comply 
with  the  law,  and  upon  receiving  such  notice  the  board 
should  summon  the  offender  before  it  to  show  cause 
as  to  why  the  fine  prescribed  in  its  local  regulations 
should  not  be  imposed,  and  upon  proving  wilful  vio- 
lation of  the  same  the  prescribed  fine  should  be  im- 
posed. If  the  local  board  fails  to  take  such  action 
upon  complaint  of  the  local  registrar,  the  latter  should 
notify  the  State  Department  of  Health,  as  failure  on 
the  part  of  a  local  board  of  health  to  correct  defects 
in  the  registration  makes  it  incumbent  on  the  State 
Commissioner  of  Health  to  send  a  representative  to 
take  charge  of  the  local  registration,  and  the  expenses 
incurred  thereby  becomes  a  charge  against  the  munici- 
pality.   (See  section  5  of  the  Public  Health  Law.) 


144  PUBLIC   HEALTH    MANUAL  ""■ 

Attention  is  called  to  the  necessity  of  seeing  that 
all  certificates  of  births  and  deaths  are  accurately  and 
properly  filled  out  before  they  are  accepted  by  the 
local  registrar.  Each  certificate  should  be  carefully 
examined  and  special  attention  given  to  make  sure 
that  the  cause  of  death  is  properly  and  fully  supplied. 
Deaths  reported  from  abscess,  hemorrhage,  cancer, 
tuberculosis,  etc.,  should  also  contain  the  information 
as  to  what  organ  or  part  of  the  body  was  affected; 
and  deaths  reported  from  injmy  should  show  nature 
of  injury  and  •  part  of  body  or  organ  affected,  and 
whether  accidental  or  otherwise.  The  Department  is 
required  each  month  to  return  certificates  of  death 
lacking  above  information,  and  if  local  registrars  would 
give  proper  attention  to  examining  the  record  at  the 
time  the  certificates  are  filed  with  them  the  State 
Department  of  Health  would  be  saved  much  annoy- 
ance and  the  registrar  the  trouble  of  having  to  obtain 
the  lacking  information  at  a  later  date,  which  neces- 
sarily takes  more  of  their  time  than  it  would  had  they 
obtained  the  information  at  the  time  the  certificate 
was  recorded. 

Where  there  has  been  no  regular  physician  in  at- 
tendance upon  the  deceased,  and  the  circumstances  of 
death,  do  not  make  it  a  coroner's  case,  the  local  health 
officer  is  required  by  law  to  fill  out  and  file  the  certifi- 
cate of  death. 

Blank  certificates  of  births,  stillbirths,  and  deaths; 
also  cards  and  envelopes  for  use  in  forwarding  monthly 
reports  to  the  State  Department  of  Health  are  fur- 
nished by  the  Department  to  local  registrars  without 
cost,  and  only  such  registration  blanks  as  are  fur- 
.nished  by  the  Department  should  be  used  by  local 
boards  of  health.  Burial  and  transit  permits,  given- 
name  blanks,  registers,  etc.,  must  be  purchased  at  local 
expense. 


rXSTPvUCTIOXS    TO    EEGISTEAES  145 

TMs  Department  also  furnishes  th.e  comity  clerks 
with  the  necessary  forms  —  marriage  licenses,  blanks, 
etc. —  to  carry  out  the  provisions  of  chapter  712  of  the 
Laws  of  1907,  the  printed  forms  being  distributed 
among  the  town  and  city  clerks  making  requisition 
for  same  on  the  county  clerk. 

Town  and  city  clerks  should  see  that  the  provisions 
of  said  act  are  complied  with  —  that  marriage  licenses 
are  not  issued  to  persons  residing  in  the  State  unless 
in  the  town  or  city  where  the  woman  to  be  married 
resides.  If  nonresidents  of  the  State  the  license  should 
be  issued  by  the  town  or  city  clerk  in  which  the  mar- 
riage ceremony  is  to  be  performed. 

The  town  and  city  clerks  issuing  marriage  licenses 
should  see  that  the  clergyman  performing  the  mar- 
riage ceremony  files  the  license  and  certificate  of  mar- 
riage within  the  time  prescribed  by  law  —  on  or  be- 
fore the  tenth  day  of  the  month  next  succeeding  the 
date  of  solemnizing  of  the  marriage  —  and  after  re- 
cording same  upon  his  register,  the  town  or  city  clerk 
should  on  or  before  the  15th  day  of  each  month  file 
in  the  office  of  the  coimty  clerk  the  original  of  each 
affidavit,  statement,  consent,  license  and  certificate 
which  has  been  filed  with  or  made  before  him  during 
the  preceding  month. 

The  coimty  clerks  are  required  to  file  a  true  copy 
of  all  such  records  with  fhe  State  Department  of 
Health  during  the  first  twenty  days  of  the  months  of 
January,  April,   July  and  October  of  each  year. 


10 


146  PUBLIC   HEALTH    MANUAL 

RULES  OF  THE  NEW  YORK  STATE  DEPARTMENT 
OF  HEALTH  FOR  THE  TRANSPORTATION  OF 
THE  DEAD 

(These  rules  having  been  duly  adopted  and  properly 
published,  have  the  force  of  law.) 

Rule  1.  The  transportation  of  bodies  dead  of  small- 
pox or  bubonic  plague  is  absolutely  forbidden  except 
upon  certification,  sworn  to  by  the  undertaker  in  charge 
of  the  remains,  and  the  certificate  of  the  health  oSicer, 
both  to  be  approved  by  the  State  Commissioner  of 
Health,  that  the  bodies  have  been  thoroughly  disin- 
fected by  (a)  arterial  and  cavity  injection  with  an  ap- 
proved embalming  fluid,  (&)  disinfecting  and  stopping 
all  orifices  with  absorbent  cotton,  and,  (c)  washing  the 
body  with  an  approved  disinfectant,  all  of  which  must 
be  done  by  a  licensed  embalmer  of  the  State  of  New 
York.  After  being  disinfected  as  above,  such  body  shall 
be  enveloped  in  a  layer  of  dry  cotton  not  less  than  one 
inch  thick,  completely  wrapped  in  a  sheet  and  bandaged, 
and  encased  in  an  air-tight  zinc,  copper  or  lead  lined 
coffin,  or  iron  casket,  all  joints  and  seams  hermetically 
sealed,  and  all  enclosed  in  a  strong,  tight  wooden  box. 
Or,  the  body  being  prepared  for  shipment  by  disinfect- 
ing and  wrapping  as  above,  may  be  placed  in  a  strong 
coffin  or  casket,  and  said  coffin  or  casket  encased  in  an 
air-tight  zinc,  copper  or  tin  case,  all  joints  and  seams 
hermetically  soldered  and  all  enclosed  in  a  strong  out- 
side wooden  box,  or  the  casket  may  be  enclosed  in  a 
hermetically  sealed  metal  case. 

Rule  2.  The  bodies  of  those  who  have  died  of  Asiatic 
cholera,  typhus  fever,  diphtheria  (membranous  croup), 
scarlet  fever  (scarlatina,  scarlet  rash),  erysipelas,  lep- 
rosy, glanders  or  anthrax,  shall  not  be  accepted  for 
transportation  unless  prepared  for  shipment  in  the  man- 
ner prescribed  by  Rule  1,  the  same  to  be  approved  and 
certified  to  by  a  local  health  officer. 


TBANSPOBTATIOX   OF   THE  DEAD  147 

Rule  3.  The  bodies  of  those  dead  of  typhoid  fever, 
puerperal  fever,  tuberculosis,  measles  and  cerebrospinal 
meningitis,  or  other  dangerous  communicable  diseases 
other  than  those  specified  in  Rules  1  and  2  may  be  re- 
ceived for  transportation  when  prepared  for  shipment 
by  filling  the  cavities  with  an  approved  embalming 
fluid,  washing  the  exterior  of  the  body  with  an  approved 
disinfectant,  stopping  all  orifices  of  the  body  with  ab- 
sorbent cotton,  and  by  being  arterially  embalmed  with 
an  approved  embalming  fluid,  aU  of  which  must  be  done 
by  a  licensed  embalmer  of  the  State  of  New  York,  and 
the  same  encased  in  a  coffin  or  casket  and  outside  wooden 
or  metal  box.  In  the  event  of  bodies  dying  of  diseases 
mentioned  in  this  rule  not  reaching  their  destination 
within  120  hours  after  the  hour  of  death,  the  casket  or 
overbox  shall  be  hermetically  sealed. 

RrxE  4.  The  bodies  of  those  dead  of  diseases  that  are 
not  contagious,  infectious  or  communicable,  may  be  re- 
ceived for  transportation  when  encased  in  a  sound 
casket  or  overbox,  provided  that  they  reach  their  des- 
tination within  thirty  hours  after  death.  If  the  body 
cannot  reach  its  destination  within  thirty  hours  after 
death,  it  must  be  prepared  for  shipment  by  filling  the 
cavities  with  an  approved  embalming  fluid,  washing  the 
exterior  of  the  body  with  an  approved  disinfectant,  stop- 
ping all  orifices  with  absorbent  cotton  and  the  body 
must  be  arterially  embalmed  with  an  approved  embalm- 
ing fluid  by  a  licensed  embalmer  of  the  State  of  Xew 
York,  and  "^the  same  encased  in  a  coffin  or  casket  and 
outside  wooden  or  metal  box. 

Rule  5.  In  cases  of  bodies  dead  of  diseases  mentioned 
in  Rules  1  and  2,  the  body  must  not  be  accompanied  by 
persons  or  articles  which  have  been  exposed  to  the  in- 
fection of  the  disease,  unless  certified  by  the  health 
officer  as  having  been  properly  disinfected;  and  before 
selling  passage  tickets,   agents  shall  carefuUy  examine 


148  PUBLIC   HEALTH    MANUAL 

the  transit  permit  and  note  the  name  of  the  passenger 
in  charge,  and  of  any  others  proposing  to  accompany  the 
body.  The  transit  permit  in  such  case  shall  specifically 
state  who  is  authorized  by  the  local  board  of  health  to 
accompany  the  remains.  In  all  cases  where  bodies  are 
forwarded  under  Rules  1  and  2  notice  must  be  sent  by 
telegraph  to  health  ofiicer  at  destination,  advising  the 
date  and  train  on  which  the  body  may  be  expected.  This 
notice  must  be  sent  by  or  in  the  name  of  the  health 
officer  at  the  initial  point,  and  is  to  enable  the  health 
officer  at  destination  to  take  all  necessary  precautions  at 
that  point. 

Rule  6.  Every  dead  body  must  be  accompanied  by  a 
person  in  charge,  who  must  be  provided  with  a  passage 
ticket  and  also  present  a  full  first-class  ticket  marked 
"  Corpse  "  for  the  transportation  of  the  body,  and  a  tran- 
sit permit  —  with  undertaker's  certificate,  name  of  de- 
ceased, date  of  death;  age,  place  of  death,  cause  of  death, 
the  point  to  which  the  body  is  to  be  shipped,  and  when 
death  is  caused  by  any  of  the  diseases  specified  in 
Rules  1  and  2,  the  name  of  the  person  authorized  by 
the  local  board  of  health  to  accompany  the  body.  The 
undertaker's  certificate  and  paster  shall  be  detached  from 
the  transit  permit  and  pasted  on  the  coffin  box.  The 
transit  permit  shall  be  handed  to  the  passenger  in 
charge  of  the  corpse.  When  a  body  is  transported  by 
express,  the  express  messenger  will  be  in  charge  of  the 
body,  hold  the  transit  permit  and  surrender  the  same 
to  the  person  to  whom  the  corpse  is  consigned. 

Rutj:  7.  Every  disinterred  body,  dead  from  any  disease 
or  cause,  shall  be  treated  as  infectious  or  dangerous  to 
the  public  health  and  shall  not  be  accepted  for  trans- 
portation unless  said  removal  has  been  approved  by  the 
local  health  authorities  having  jurisdiction  where  such 
body  is  disinterred,  and  the  consent  of  the  health  au- 
thorities of  the  locality  to  which  the  corpse  is  consigned 


TBAXSPOETATIOX    OF    THE   DEAD  149 

has  first  been  obtaiiied;  and  if  the  deatli  v:siS  from 
causes  specified  in  Rule  1  the  approval  of  the  State  Com- 
missioner of  Health  must  likewise  be  obtained.  All 
such  disinterred  remains  shall  be  enclosed  in  a  her- 
metically sealed  zinCj  tin  or  copper  lined  coflfin  or  box 
or  hermetically  sealed  metal  case.  Bodies  deposited  in 
receiving  vaults  shall  not  be  treated  and  considered  the 
same  as  buried  bodies  when  originally  presented  by  a 
licensed  embalmer  of  the  State  of  ^S'ew  York  as  directed 
in  Eules  1,  2  and  3  (according  to  the  nature  of  the 
disease  causing  death),  provided  shipment  takes  place 
within  thirty  days  from  time  of  death.  After  thirty 
days  all  such  bodies  must  be  enclosed  in  a  hermetically 
sealed  casket  or  in  a  casket  enclosed  in  a  hermetically 
sealed  (soldered)  zinc,  tin  or  copper  lined  box  or  her- 
metically sealed  metal  case,  and  permission  must  be  ob- 
tained from  the  health  authorities  of  the  locality  to 
which  the  corpse  is  consigned  before  the  shipment  is 
made.  Bodies  not  so  prepared  and  deposited  in  receiv- 
inff  vaults  will  l>e  treated  the  same  as  buried  bodies. 

Rule  8.  The  term  •"'  approved  embalming  fluid  '*'"  as 
used  in  these  rules  means  an  embalming  fluid  that  has 
been  submitted  to  a  bacteriological  test  and  approved 
by  the  Board  of  Embalming  Examiners  of  the  State  of 
Xew  York.  A  5  per  cent,  solution  of  carbolic  acid,  a 
1-500  solution  of  corrosive  sublimate  or  14  per  cent,  of 
a  40  per  cent,  solution  of  formaldehyde  are  approved  as 
disinfectants  for  external  washing  of  bodies  when  re- 
quired by  these  rules.  Other  prepared  disinfectants  of 
equal  germicidal  action  may  also  be  used, 

PASTER 

Special  Ixstetctio^ts. —  A  burial  case  containing  a 
corpse  must  not  be  received  for  transportation  unless 
the  person  in  charge  presents   a  permit  from  the  local 


150  PUBLIC   HEALTH   MANUAL 

board  of  health,  and  an  undertaker's  certificate  that 
the  body  has  been  prepared  for  shipment  in  accordance 
with  the  laws  of  the  State;  nor  will  it  be  received 
eyen  then  if  any  fluids  or  offensive  odors  are  escaping 
from  the  case. 


TRANSIT  PERMIT 

TRANSPORTATION  OF  CORPSE 

New  York  State  Department  of  Health 


Transit  Permit  No. 


permit    of    local   board    of    HEIALTH 

This  permit  must  he  properly  signed  and  presented,  icith 
Undertaker's  Certificate,  to  the  Railroad,  Express 
or  other  Transportation  Agent,  hefwe  a  tody  can 
he  shipped. 

Co.  of   N.  Y., 190.. 

Permission  is  hereby  given holder  of  Under- 
taker's License  No to  remove  for  burial  at 

(When  obtainable)    Cemetery  at State  of 

the  body  of who  died   at N.  Y.,  on 

191..,   at M.        Aged ....  years ....  months 

days,   the    cause    of    death   being which 

necessitates   shipment  under   Rule  No of  the  Rules 

of  the  New  York  State  Department  of  Health  for  the 


TEAXSPOETATIOX   OF   THE  DEAD  151 

Transportation  of  tlie  Dead,  as  printed  on  the  back  of 

this  Permit. 

Name  of  person  in  charge  of  transit, 


Signed 


(Official  Title) 

This  Permit  and  Coupon  must  he  detached  and  de- 
livered to  the  Person  in  charge  of  the  Corpse. 

TRANSPORTATION    OF    DECEASED    PERSONS. 
To  Transportation  Agents  Concerned: 

You  will  in  no  case  receive  a  corpse  for  transportation 
unless  accompanied  by  a  board  of  health  certificate,  also 
an  undertaker's  certificate  that  the  body  has  been  pre- 
pared for  burial  and  shipment  in  accordance  with  the 
rules  of  the  State  Department  of  Health,  nor  loill  you 
receive  it  even  loith  such  certi-ficates  if  fluids  are  escap- 
ing from  the  case  or  it  has  become  offensive  in  any 
degree.  One  full  first-class  limited  or  unlimited  ticket 
will  be  required  for  the  transportation  of  a  corpse  with- 
out regard  to  the  age  of  the  deceased,  and  a  corpse  will 
not  be  taken  for  transportation  except  there  is  a  passen- 
ger with  it  in  charge.  The  word  "  Corpse "  should  be 
plainly  written  on  the  face  of  a  local  and  each  coupon  of 
a  coupon  ticket.  A  record  must  be  made  of  all  bodies 
shipped  and  carried,  on  the  back  of  your  station  and 
trip  reports,  giving  name  of  deceased,  and  destination. 

It  will  be  the  duty  of  agents  and  baggage  agents  to 
see  that  each  burial  case  is  properly  marked  on  "  Paster," 
giving  date  and  at  what  station  shipped,  point  of  des- 
tination, "  State,"  number  and  form  of  ticket,  name  of 
passenger  in  charge  and  place  of  residence,  with  name 
of  agent.     If  the  corpse  is  destined  to  a  point  beyond 


152  PUBLIC   HEALTH    MANUAL 


I 


tlie  initial  line,  the  initials  of  each  road  over  which  it 
passes  must  be  written  on  the  paster;  also  the  terminal 
point  of  each  road  at  which  transfer  is  made  with  con- 
necting line,  as  shown  on  the  coupons  of  the  ticket. 

You  will  see  that  the  "  Certificate  of  Undertaker "  is 
properly  filled  out  by  him,  and  the  paster  is  properly 
filled  out  by  yourself  and  is  securely  pasted  to  the  coffin 
?30x  before  it  is  put  into  the  car,  and  the  permit  remain- 
ing you  will  hand  to  the  passenger  in  charge  of  the 
corpse. 

All  this  information  is  necessary  to  insure  the  prompt 
and  correct  transportation  of  the  corpse. 


TUBEBCTILOSIS  153 

CIRCULARS  ON  COMMUNICABLE  DISEASES 

:.ARYNGEAL  AND  PULMONARY  TUBERCULOSIS 
All  cases  to  be  reported. — As  tuberculosis  is  a  danger- 
>us  communicable  disease,  the  State  Commissioner  of 
Bealth  requires  tbat  a  registry  of  all  cases  be  kept, 
Either  at  the  office  of  a  local  health  department,  as  in 
cities  where  proper  facilities  exist  for  its  maintenance, 
or  Sit  the  office  of  the  State  Department.  Cards  and 
blanks  for  reporting  such  cases  are  provided  by  the 
Department,  and  such  reports  should  be  forwarded  to 
the  Department  within  twenty-four  hours  after  the 
health  officer  has  been  notified  of  the  discovery  of  cases. 
Notice  of  removal  of  a  case  should  also  be  sent. 

Energetic  measures  necessary. — ^\Yhile  tuberculosis  is 
known  to  be  both  preventable  and  curable,  it  is  more 
widespread  than  any  other  disease,  and  the  mortality 
records  of  the  New  York  State  Department  of  Health 
show  that  it  causes  10  per  cent,  of  all  the  deaths  in  the 
State  and  one-third  of  all  deaths  between  the  ages  of 
fifteen  and  fifty  years.  Add  to  the  fatality  attending 
the  disease,  the  enforced  idleness  over  long  periods  of 
its  victims  who  are  for  the  most  part  in  the  productive 
period  of  life,  and  it  is  evident  that  the  State  suffers 
a  tremendous  economic  loss  owing  to  its  prevalence. 
This,  and  the  misery  it  occasions  in  so  many  house- 
holds, demand  the  most  determined  efforts  upon  the 
part  of  the  medical  profession  in  general,  and  health 
officers  in  particular,  in  controlling  the  disease  and  pre- 
venting its  spread. 

A  campaign  of  education. —  The  problem  is  essentially 
a  sim.ple  one  —  no  broadcast  scattering  of  sputum,  no 
tuberculosis;  but  its  very  simplicity  adds  to  the  diffi- 
culty.    It  is  hard  to  control  indefinitely  the  habits  of 


154  PUBLIC   HEALTH    MANUAL 

every  day  life,  yet  this  is  what  must  be  done.  Her* 
if  anywhere,  education  is  necessary.  We  must  mak 
the  people  understand  that  consumption  is  a  gerc 
disease  and  that  the  germs  are  conveyed  to  other 
through  the  sputum. 

Circular  on  consumption.— As  an  aid  in  this  campaigi 
of  education,  the  State  Health  Department  has  issued  ; 
circular  on  Consumption,  conveying  this  information  1: 
language  as  little  technical  as  possible  and  giving  : 
series  of  rules  that  consumptives  should  observe,  i 
card  folder  for  the  pocket  giving  important  facts  abou 
consumption  in  clear  paragraphs  is  also  issued.  Th 
health  officer  should  see  that  this  material,  or  instruc 
tion  equally  explicit,  is  placed  in  the  hands  of  ever; 
consumptive  in  his  jurisdiction.  The  State  Departmen 
will  gladly  furnish  them  in  any  quantity  a  health  office 
can  use.  It  would  be.  well  to  send  a  copy  to  ever 
physician,  clergyman,  newspaper  editor  and  public  schoo 
teacher,  asking  for  their  assistance  in  disseminating  th 
information  it  contains.  Health  officers  ought  to  famil 
iarize  themselves  with  the  matter  contained  in  this  cir 
cular  and  the  rules  to  be  observed. 

Printed  matter.— "  Handbook  of  County  Tuberculosi 
Hospital-Sanatoria:  Suggestions  as  to  Site  and  Con 
struction;"  "Directions  for  Living  and  Sleeping  in  th 
Open  Air,"  are  pamphlets  published  by  the  Nationa 
Association  for  Study  and  Prevention  of  Tuberculosi 
and  the  State  Department  of  Health,  and  are  sent  o; 
application  to  health  officers.  "Tuberculosis,"  edite( 
by  Arnold  C.  Klebs,  M.D.,  is  a  recently  issued  volum- 
of  nearly  1,000  pages  by  numerous  authors.  "An  Illus 
trated  Handbook  for  Tuberculosis  Committees  "  is  issue< 
by  the  State  Charities  Aid  Association,  105  East  Twenty 
second  street,  Xew  York.    Price  50  cents. 


TUBEECUXOSIS  155 

Examination  of  sputum. — ^While  a  skillful  diagnos- 
tician can  often  determine  the  existence  of  tuberculosis 
in  the  lung  before  bacilli  can  be  found  in  the  sputum, 
and  while  the  absence  of  tubercle  bacilli  in  one  or  more 
specimens  of  sputum  does  not  absolutely  rule  out  tuber- 
culosis, their  presence  is  an  absolute  indication  of  the 
existence  of  the  disease.  Hence,  physicians  should  be 
urged  to  have  a  bacteriological  examination  of  sputum 
made  whenever  a  patient  exhibits  such  suspicious  symp- 
toms as  loss  of  weight,  impaired  appetite,  debility,  in- 
creased evening  temperature,  etc.  If  neither  the  physi- 
cian nor  the  health  officer  is  iprepared  to  make  such 
examination,  the  State  Hygienic  Laboratory  will  do  so 
free  of  charge.  Special  containers  are  furnished  by  the 
Department  for  the  mailing  of  specimens.  Reports  of 
examinations  are  mailed  to  the  health  officer  and  to  the 
attending  physician,  if  the  latter's  address  is  given. 

Expectoration  and  cuspidors. —  Expectoration  on  side- 
walks and  in  public  buildings  is  dangerous  and  should 
be  punishable  by  a  reasonable  fine,  and  the  punishment 
should  be  enforced.  The  health  officer  should  use  his 
influence  to  procure  the  provision  of  an  adequate  supply 
of  covered  cuspidors  in  public  buildings,  factories,  etc., 
and  should  see  that  those  responsible  for  the  cleaning  of 
them  do  the  work  thoroughly.  The  contents  of  cus- 
pidors should  be  thoroughly  disinfected  or  better  still, 
boiled,  before  being  emptied  into  sewers,  privies,  etc. 

Consumptives  and  the  public  milk  supply. — A  con- 
sumptive should  not  be  permitted  to  work  in  a  dairy  or 
come  in  close  proximity  to  the  vessels  in  which  milk 
is  to  be  collected  or  stored ;  nor  should  he  be  allowed  to 
expectorate  in  stables  or  pastures  occupied  by  cattle 
or  in  places  where  chickens  scratch  and  feed. 


15^  PUBLIC    HEALTH    ^lANUAL 

Public  laundries. —  Clothing  or  bed-linen  used  by  a 
consumptive  should  not  be  permitted  to  go  to  a  public 
laundry  unless  it  has  been  kept  moist  with  a  disinfect- 
ant solution  since  it  was  set  aside  to  be  washed. 

Disinfection  of  rooms. —  Rooms  occupied  by  a  con- 
sumptive should  be  thoroughly  disinfected  twice  a  year 
at  least  and,  on  death  or  removal  of  the  patient,  be  again 
thoroughly  disinfected  either  by  or  under  the  instruc- 
tion of  the  health  officer.  (See  pamphlet  on  Disinfect- 
ants aiid  Disinfection  for  suggestions.)  Where  advis- 
able, the  health  officer  should  also  require  the  owner  of 
the  premises  to  renovate  the  room  or  rooms  by  repaper- 
ing,  etc.  If,  in  spite  of  thorough  disinfection  and  reno- 
vation, new  cases  continually  arise  in  a  house  that  has 
been  occupied  by  a  consumptive,  the  premises  should  be 
condemned  and  destroyed. 

Dust. —  Dust  particles  containing  germs  being  a  recog- 
nized means  of  infection,  sanitary  authorities  should  re- 
quire that  care  ghould  be  exercised  in  sweeping,  etc., 
not  only  in  the  homes  of  consumptives,  but  in  all  public 
buildings  and  on  the  streets.  Ordinances  governing 
this  should  be  enacted  and  enforced  wherever  possible. 
The  beating  of  carpets  and  rugs  should  be  strictly  regu- 
lated, _  and  forbidden  in  built-up  communities.  The 
vacuum  system  of  cleaning  should  be  encoui-aged.  Hand 
vacuum  cleaners  should  not  be  rented,  but  owned. 

Coughing  and  sneezing.—  Health  officers  should  bear  in 
mind  that,  as  stated  in  the  circular  on  Consumption 
issued  for  popular  -distribution,  one  of  the  commonest 
ways  of  spreading  infection  is  the  unconscious  ejection 
of  particles  of  spittle  containing  the  germs  during  cough- 
ing and  spitting,  and  should,  either  personally  or 
through  the  attending  physician,  particularly  caution 
consumptives  about  this. 


ruBEEcntosis  '        157 

Inspection  of  premises. —  The  liealtli  officer  sliould, 
of  course,  avoid  anything  that  savors  of  interference 
with  an  attending  physician's  care  of  a  case,  and  if  the 
proper  co-operation  exists  between  them,  an  inspection 
of  the  premises  by  the  health  officer  shonld  not  be  neces 
sary.  In  the  case  of  consumptives  who  are  not  in  th 
regular  care  of  a  physician,  however,  an  inspection  of 
the  premises  should  be  made  from  time  to  time. 

Hospital-Sanatoria. —  Unless  proper  supervision  can 
be  given  at  home,  cases  of  tuberculosis  should  be  placed 
in  a  sanatorium.  Chapter  341,  Laws  of  1909,  authorized 
the  establishment  and  maintenance  of  such  by  the  board 
of  supervisors  of  each  county.  A  Handbook  on  County 
Tuberculosis  Hospital-Sanatoria  has  been  prepared  by 
the  Department  containing  suggestions  as  to  their  site, 
construction  and  management,  with  the  full  text  of  the 
law,  and  it  will  be  sent  to  health  officers  on  application. 

School  children  and  tuberculosis. —  In  the  fight  against 
tuberculosis  health  officers  should  secure  the  co-opera- 
tion of  school  teachers  by  getting  them  to  inculcate  the 
observance  of  the  following  rules  by  their  pupils: 

Do  not  spit  except  in  a  spittoon  or  a  piece  of  cloth  or 
a  handerkerchief  used  for  that  purpose  alone.  On  your 
return  home  have  the  cloth  burned  by  your  mother  or 
the  handkerchief  put  in  water  until  ready  for  wash. 

Never  spit  on  a  sidewalk,  slate,  floor,  or  playground. 

Do  not  put  your  fingers  into  your  mouth. 

Do  not  pick  your  nose  or  wipe  it  on  your  hand  or 
sleeve. 

Do  not  wet  your  finger  in  your  mouth  when  turning 
the  leaves  of  books. 

Do  not  put  pencils  in  your  mouth  or  wet  them  with 
your  lips. 

Do  not  hold  money  in  your  mouth. 


158  PUBLIC  HEALTH   MANUAL 

Do  not  put  pins  in  your  mouth. 

Do  not  put  anything  in  your  mouth  except  food  and 
drink. 

Do  not  swap  apple  cores,  candy,  chewing  gum,  half- 
eaten  food,  whistles,  bean  blowers,  or  anything  that  is  I 
put  in  the  mouth. 

Peel  or  wash  your  fruit  before  eating  it. 

Never  sneeze  or  cough  in  a  person's  face.  Turn  your 
face  to  one  side  or  hold  a  handkerchief  before  your 
mouth. 

Keep  your  face  and  hands  and  finger-nails  clean. 
Wash  your  hands  with  soap  and  water  before  each  meal. 

When  you  don't  feel  well,  have  cut  yourself,  or  have 
been  hurt  by  others,  don't  be  afraid  to  report  to  the 
teacher. 

Be  just  as  careful  and  cleanly  about  your  person  at 
home  as  in  school. 

Clean  your  teeth  with  tooth-brush  and  water,  if  pos- 
sible, after  each  meal;  but  at  least  on  getting  up  in 
the  morning  and  on  going  to  bed  at  night. 

Do  not  kiss  any  one  on  the  mouth  or  allow  anybody 
to  do  so  to  you. 

Learn  to  love  fresh  air  and  learn  to  breathe  deeply 
and  do  it  often. 


TYPHOID   FEVEB  159 

TYPHOID  FEVER 

All  cases  to  be  reported. —  Typhoid  fever  is  a  com- 
unicable  infectious  disease,  all  cases  of  wMch  must  be 
iported  at  once  by  the  attending  physician  to  the  local 
ialth  officer  or  board  of  health,  who  in  turn  should 
)tify  the  State  Department  of  Health  within  twenty- 
ur  hours. 

Blanks  are  provided  by  the  Department  for  the  mak- 
g  of  these  reports.  There  is  no  disease  for  which  the 
epartment  desires  more  complete  returns  of  every  indi- 
dual  case  than  this,  and  the  health  officer  is  urged  not 
ily  to  fill  as  fully  as  he  can  replies  to  the  questions, 
it  to  add  information  which  the  formal  cards  may  not 
11  far. 

Circular  on  typhoid. —  The  State  Department  of  Health 

IS  issued  a  circular  on  Typhoid  Fever  for  gratuitous 

stribution,    especially    in    households    where    typhoid 

ver   is   existing   or   has   existed.      This   circular   gives 

me  general   information  in  plain  language  regarding 

.e  means  of  contracting  and  preventing  typhoid  fever. 

[aese    can    be    obtained    from    the    Department   in   any 

iiantity,  and  every  health  officer  should  see  to  it  that 

!  is  well   supplied  and  that  the  same  or  explicit  in- 

rmation  and  instruction  of  like  character  is  given  to 

e  heads  of  families  visited  by  this  disease. 

It  is  most  desirable  that  the  public  shall  be  informed 

to  the  nature  of  typhoid  fever  and  the  conditions  on 

hich  it  depends.     In  times  of  epidemic  the  circulars 

■Quid  be  widely  distributed.     The  health  officer  should 

oroughly   familiarize   himself   with    its    contents    and 

force  its  rules. 

The  typhoid  bacillus. —  This  specific  agent  of  typhoid 
ver  is  the  only  cause  of  the  disease,  and  no  medium 

ill  develop  it  which  does  not  contain  this  bacillus.     It 


160  PUBLIC   HEALTH   MANUAL 

finds  exit  from  the  body  of  the  sick  mostly  in  the  feoe 
and  urine  and  gains  entrance  to  the  body  only  by  wa 
of  the  alimentary  tract. 

It  is  not  disseminated  through  the  air,  nor  taken  b 
inhalation,  either  of  the  air  of  the  sick  room  or  < 
sewers.  It  may  be  taken  directly  by  contact  with  tl 
sick  or  the  sick  room,  but  only  by  hands  soiled  froi 
waiting  on  the  patient,  use  of  their  food,  or  unwashe 
dishes,  from  soiled  door  knobs  and  otber  ways,  whic 
furnish  a  way  by  which  living  bacilli  can  be  carried  t 
a  digestive  tract. 

These  micro-organisms  are  disseminated  In  a  variet 
of  ways  but  the  medium  must  be  one  which  delives 
them  into  the  stomach  in  a  living  condition.  Laboratoi 
tests  may  witb  difficulty  discover  them  in  these  medi 
They  are  resistant  to  cold,  but  not  to  heat  and  dryin 
They  thrive  variously  in  different  media  and  enviro: 
ments. 

Water-borne  infection. — Water  is  the  chief  medium  c 
infection.  In  it  bacteria  live  for  varying  lengths  of  tim 
according  as  it  is  free  from  other  inimical  bacteria,  floi 
ing  or  still  water,  exposure  to  light  and  aeration;  the 
shortest  existence  being  in  flowing  sewage.  In  stream 
wells  and  reservoirs  of  drinking  water,  they  live  fro 
two  to  three  months.  Water  becomes  infected  fro 
drains  carrying  living  bacilli  or  from  the  soil,  in  tl 
latter  case  through  surface  drainage  or  undergroui 
drainage.  Outbreaks  in  the  country  often  follow  vi 
lent  rain  storms  in  the  late  autumn  by  swelling  theJ 
channels  which  carry  the  germs  to  wells  and  strean 
How  long  they  can  live  in  soil  is  not  known  but  und 
favorable  conditions  very  likely  from  season  to  seaso 

Food  infection. —  Compared  with  water  this  is  a  mim 
means    of    infection.      Anv    article    of    food    taken   u 


TYPHOID   FEVEK  161 

sterilized  by  cooking  after  becoming  infected  may  cause 
typhoid  fever.  Prominent  is  milk  which,  is  an  ideal 
.medium  for  the  sustained  Titality  of  these  bacilli,  and 
is  mostly  taken  uncooked.  So  likewise  butter  in  which 
[the  bacilli  may  live  long.  Milk  epidemics  have  their 
special  characteristics,  which  distinguish  them.  Milk 
becomes  infected  from  the  infected  hands  of  the  milk 
man,  from  bringing  the  milk  or  the  milk  utensils  in 
iproximity  to  the  sick  room,  or  through  their  being 
handled  by  attendants  on  the  sick,  or  water  used  to 
liilute  the  milk  or  to  wash  milk  utensils,  and  flies  carry- 
\ng  typhoid  excreta  may  light  on  the  washed  cans  or 
bottles  exposed  to  the  open  air.  Other  food  such  as 
pysters  fattened  in  sewage  streams,  uncooked  vegetables 
washed  in  infected  water  or  otherwise  poisoned  may 
jause  typhoid  fever. 

I  House  fly  infection. —  If  flies  are  allowed  access  to  a 
typhoid  fever  sick  room,  to  the  dejecta,  or  soiled  vessels, 
:o  unscreened  priw  vaults,  in  which  discharoes  from  a 
typhoid  patient  or  a  typhoid  bacillus  carrier  are  de- 
30sited,  they  may  carry  infected  matter  to  any  article 
Df  food  within  the  range  of  their  excursion,  which,  how- 
iver,  is  not  large.  Cases  of  supposed  aerial  transmis- 
non  are  to  be  explained  in  this  way.  Well  authenti- 
;ated  cases  are  reported  where  the  fly  carried  typhoid 
nfection  for  a  distance  of  more  than  100  feet.  Should 
lies  gain  admission  to  a  typhoid  sick  room  they  should 
ye  killed  and  not  allowed  to  escape. 

I 

I   Bacilli   carriers. — Living  bacilli  may  continue   in   the 

I'eces   and  urine   of   an  individual   for   indefinitely  long 

:)eriods  after  the  fever  has  ceased.     Such  persons  are  a 

lOurce  of  infection,  either  by  means  of  their  soiled  hands 

;oming  in  contact  with  food,  such  as  might  be  the  case 

11 


162  PUBLIC  HEALTH   MANUAL 

with  a  cook,  milk  man,  grocer  or  otlier  person  handling 
food  which  might  be  eaten  in  an  uncooked  state. 

A  convalescing  typhoid  patient  should  be  regarded  as 
a  possible  source  of  danger  to  others,  until  by  micro- 
scopic examinations  he  is  found  not  to  be  a  bacillus 
carrier. 

Aid  to  diagnosis.— The  Widal  test  is  a  valuable 
means  for  verifying  the  diagnosis  of  tj-^phoid  fever,  and 
the  outfit  with  directions  will  be  sent  to  health  officers 
on  application  to  the  department.  It  is  to  be  noted 
that  this  reaction  often  does  not  occur  before  the  second 
week  of  the  disease,  that  it  may  occur  from  the  serum 
of  patients  who  are  thought  to  have  recovered  from  a 
previous  attack  of  typhoid  fever,  and  in  some  unques- 
tioned cases  it  may  fail  to  occur.  It  is  frequently  of 
decisive  importance  where  the  clinical  symptoms  are  ir- 
regular. 

Ehrlich's  so-called  diazo-reaction  of  the  urine  is  of 
some  early  value,  though  its  best  results  are  obtained 
about  the  tenth  day  and  often  disappear  after  the 
second  week.  WTiile  it  occurs  in  other  febrile  diseases, 
few  of  them,  however,  give  rise  to  any  doubt  as  to 
diagnosis. 

Characteristics  of  outbreaks. —  Every  case  of  typhoid 
fever,  as  well  as  every  epidemic,  ought  to  be  traced  to 
its  source.  Epidemics  have  characteristics  of  their  own, 
a  detailed  study  of  which  should  be  made  in  investigat- 
ing an  outbreak. 

An  abrupt  onset  of  an  outbreak,  the  community  hav- 
ing been  previously  free,  must  be  due  to  a  freshly  im 
ported  infection.  Milk-borne  epidemics  are  usually  ful 
minant,  many  cases  occurring  suddenly  within  a  weel 
and  sometimes  with  spasmodic  recurrences;  the  reasons 
for  this  are  obvious.  The  cases  will  be  found  largelj 
following  a  certain  milk  route. 


TYPHOID  FEVES  163 

A  previously  pure  water  supply  may  receive  infection 
rom  a  case  of  typhoid  fever  abruptly  appearing  on  the 
ffluents  of  its  watershed  or  from  an  infected  fertilizer 
arried  from  fields  to  the  streams  by  heavy  rains.  An 
ifected  food,  such  as  oysters,  will  also  cause  a  ful- 
linant  outbreak,  since  the  developing  cause  is  only 
asual  and  all  who  are  taken  ill  are  taken  at  once. 

On  the  other  hand  persistence  of  typhoid  fever  in  a 
Mmnunity  indicates  a  persistent  source,  and  this  is 
sually  an  infected  water  supply.    This  may  be  true  of 

dwelling  as  well  as  of  a  community,  but  persistency 

1  a  dwelling  should  lead  one  to  suspect  the  presence 
f  a  bacillus  carrier. 

The  distribution  of  cases  shows  either  that  the 
)urce  is  general,  if  they  occur  in  all  parts  of  a  com- 
Lunity,  or  of  limited  application,   if  restricted  in   dis- 

ibution.  If  infected  milk  causes  an  outbreak,  the  cases 
ill  not  only  develop  abruptly  but  most  of  them  will 

2  along  the  milk  route,  and  lacking  these  character- 
itics  this  suspected  cause  of  the  epidemic  can  be  dis- 
'dssed. 

Investigation  work.—  The  origin  of  the  infection  in  a 
iven  case  or  in  an  epidemic  is  traced  by  recognizing 
s  source  as  the  typhoid  bacillus.  The  conditions 
Qder  which  this  is  developed,  lives  and  gains  access  to 
s  subject  and  the  phenomena  which  characterize  the 
itbreak,  should  be  carefullv  studied.  It  is  su^o-ested 
lat  it  will  materially  help  the  study  of  an  epidemic 
>  outline  a  map  of  the  locality  and  mark  on  it  the 
cation  of  each  infected  house  with  the  date  of  onset, 
le  water  used,  the  milk  or  other  suspected  food,  the 
je  and  occupation  of  patients,  thus  fixing  the  dis- 
ibution,  date  and  other  facts  of  the  outbreak.  Note 
16  history  of  the  community  and  dwelling  as  to  typhoid 
ver  in  previous  years.     There  should  be  a  record  of 


164  PUBLIC  HEALTH  MANTJAti 


rain  fall,  or  thaw,  as  a  heavy  precipitation  may  carrj 
infection  from  the  banks  or  soil  into  a  stream  or  wells 
The  water  supply  and  conditions 'affecting  it  are  t 
be  investigated.     This  should  include  not  only  the  usua 
water    supply,    but    that    used   prior    to    the    onset   o 
the    outbreak.      Note    absence    from    home    about    tha 
period  of  time   to   ascertain  nonresident  infection,   an 
report    findings    to    the    State    Department    of    Healtl 
If  water   is   suspected  of  being  infected,   samples  maj 
be  sent  to  the  State  Hygienic  Laboratory  for  analysi. 
Such  samples  must  be  sent  by  the  local  health  office  i 
who    must   be    governed   by    the   rules    and   regulatioij 
issued  by  the  Department  in  relation  to  the  collectic 
and  analysis  of  samples  of  water.     No  test  is  liable    j 
discover  the  presence  of  the  typhoid  bacillus  itself  ij 
water,   milk,   or  other  media,   but   the   presence  of   i| 
testinal  matter  in  water  will  show  its  possible  prej 
ence  along  with  it.  In  all  cases  where  the  water  is  su' 
pected  it  should  be  boiled  before  using.     Milk  depo 
and  dairy  farms  may  have  typhoid  fever,  because  of 
walking  case  or  bacilli  carrier  among  those   employ, 
in   them.     The   work   of   flies   or    other   sudsidiary  i 
fluences  must  also  be  borne  in  mind.    While  the  propo;- 
tion  may  appear  plain  on  its   surface,   its   solution  t 
sometimes  a  difficult  one.      The   State  Department  : 
Health  is  always  ready  to  lend  every  possible  assistan  . 

Management  of  outbreak.— The  cause  should  be  j- 
moved.  Of  especial  importance  is  the  exclusion  of  fl: 
from  the  sick  room  or  from  whatever  comes  from  ; 
the  disposal  of  excreta  from  the  patient,  and  guardis 
the  attendants  from  contact  infection. 

No  milk  handled  by  any  one  who  has  recently  I: 
typhoid  fever  himself,  or  who  has  it  in  his  househcl 
should  be  sold,  without  the  assurance  that  proper  pv 
cautions  have  been  taken.  I 


TYPHOID   FEVER  165 

If  the  water  is  suspected  it  should  be  boiled  before 
sing  to  drink  or  to  wash,  dishes  or  any  food  to  be 
aten  raw.  The  details  of  rules  for  the  control  of 
adividual  cases  are  given  in  the  popular  circular  on 
^hoid  fever  issued  by  the  State  Department  of  Health. 


» 


166 


PUBLIC  HEALTH  MAITOAl 


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SMAXXPOX  167 

SMALLPOX 

All  cases  to  be  reported. — All  cases  of  smallpox  must 
be  reported  as  soon  as  discovered  by  tbe  attending  physi- 
cian to  the  local  health  officer  or  board  of  health,  -who, 
in  turn,  should  notify  the  State  Department  of  Health 
within  twenty-four  hours.  Blanks  are  provided  by  the 
Department  for  the  making  of  these  reports. 

Characteristics  of  smallpox. —  It  is  highly  contagious 
Very  few  escape  taking  it  on  exposure  unless  they  have 
had  either  smallpox  or  vaccina.  While  it  is  early  con- 
tagious, it  is  most  contagious  after  the  eruption  appears 
and  continues  contagious  until  the  skin  is  clear. 

It  is  contracted  only  by  exposure  to  emanations  from 
the  bodies  of  ipersons  sick  with  the  disease,  or  to  articles 
which  have  become  infected  from  them.  Bad  sanitation 
alone  never  can   cause  it. 

The  vitality  of  its  virus  is  great.  Infected  articles 
if  kept  from  dampness  and  high  temperature  may  spread 
the  disease  long  after  the  original  outbreak.  Its  in- 
dilative  period  is  generally  from  twelve  to  fourteen 
days.  It  is  rarely  shorter  and  rarely  it  may  be  twenty 
days. 

Intensity. —  It  may  be  the  mildest  of  the  infe<;tious 
diseases,  so  that  after  the  initial  fever  there  are  only  a 
few  ill-defined  lesions  on  the  skin  and  no  subsequent 
malaise.  Again  it  may  be  the  gravest  and  most  re- 
pulsive confluent  or  fatal  hemorrhagic  smallpox.  It 
is  seen  in  all  grades  of  intensity.  The  severe  may  be 
contracted  from  the  mild  or  the  mild  from  the  severe. 
The  mild  form  is  now  mostly  seen  throughout  the  State. 

Course. —  It  has  an  initial  fever  generally  well  marked, 
resembling  an  attack  of  the  grip,  which  lasts  three  days, 
subsides  as  the  eruption  appears  so  that  the  patient 
may    declare   himself    getting    well     ( seen    in   no    other 


168  PUBLIC   HEALTH   MANUAL 

eruptive    fever).      If   the    case    is   mild    no    subsequent 
fever  nor  malaise  may  occur. 

Eruption. — An  eruption  of  red  papules  appears  at  the 
end  of  the  third  day,  first  and  always  most  abundantly 
on  the  face,  on  the  hands  and  wrists.  The  papules  be- 
come vesicular,  and  the  clear  fluid  may  dry  leaving  an 
induration  which  may  continue,  or  in  mild  cases  it  may 
abort  at  this  stage.  In  any  case  there  is  an  appre- 
ciable lesion  from  ten  to  twenty-one  days,  the  amount 
of  the  lesion  varying  from  very  few  to  confluence. 

Diagnosis. —  The  diagnosis  is  based  on  the  almost  in- 
variably present  initial  fever  which  will  at  least  show 
itself  as  a  malaise  and  falls  after  three  days  when  the 
eruption  appears;  on  the  characteristic  location  of  the 
eruption,  the  chest  being  free  as  compared  with  the 
face;  on  the  papular  quality  of  the  lesion  and  its  pro- 
longed persistence;  on  the  appearance  of  all  lesions 
within  forty-eight  hours.,  and  the  absence  of  recent 
lesions  alongside  of  older  ones,  as  seen  in  chickenpox. 

If  there  is  doubt  in  the  diagnosis  of  a  case,  the  State 
Department  of  Health  will  furnish  counsel,  on  notifica- 
tion by  telegraph  or  otherwise,  from  the  medical  officers, 
a  list  of  whom  vrill  be  found  published  in  this  Manual. 
In  the  meantime  the  patient  should  be  kept  in  isolation, 
and  considered  a  menace  to  public  health  until  other- 
wise shown.  It  should  not  be  forgotten  that  many 
mild  cases  after  the  initial  fever  are  so  slightly  indis- 
posed as  to  be  able  to  go  about  their  work,  carrying 
infection  to  those  with  whom  they  may  come  in  contact. 
These  mild  cases  are  the  most  prolific  ones  in  spreading 
the  disease,  and  the  most  violent  form  may  come  from 
one  ever  so  mild. 

With  smallpox,  as  icith  all  communicable  diseases, 
treat  suspicious  cases  as  dangerous  and  give  the  public 
the  benefit  of  the  doubt. 


SMAILPOX  169 

Vaccination  the  only  safeguard. —  Smallpox  is  one  of 
the  few  infectious  diseases  that  is  strictly  preventable. 
If  every  one  is  properly  vaccinated  there  will  be  no 
smallpox.  This  fact  is  established  by  its  history  in  the 
past  and  the  practical  experience  of  men  whose  regular 
business  it  is  to  protect  the  public  health  from  epidemic 
invasions  of  all  kinds.  In  Germany,  where  vaccination 
is  compulsory  upon  all,  the  disease  is  practically  un- 
known, and  smallpox  hospitals  are  not  maintained. 
While  everything  except  vaccination  is  of  minor  im- 
portance, either  to  protect  people  from  smallpox  or  to 
control  an  outbreak,  patients  should  be  rigidly  quaran- 
tined throughout  entire  disease,  and  thorough  disinfec- 
tion of  patients  and  premises  done  after  recovery. 

The  school  vaccination  law. —  The  only  compulsory 
law  in  this  State  is  section  200  of  article  XII  of  the 
Public  Health  Law,  which  provides  that  no  person,  not 
vaccinated,  shall  be  admitted  to  the  public  schools,  and 
directs  the  school  trustees  or  other  officers  having  charge 
of  such  schools  to  enforce  this.  The  constitutionality 
of  the  law  has  been  fully  established,  and  in  its  enforce- 
ment it  has  the  co-operation  of  the  State  Education 
Department. 

Duties  of  health  boards. —  Boards  of  health  are  re- 
quired by  section  24  of  article  I  of  the  Public  Health 
Law  to  guard  against  the  introduction  of  contagious 
diseases  in  their  municipalities.  The  health  officer,  as 
the  executive  officer  of  the  board  of  health,  should  see 
that  the  law  requiring  the  vaccination  of  school  children 
is  enforced.  He  should  also  endeavor  to  secure  from  the 
officers  of  all  other  schools,  the  proprietors  of  factories 
and  those  having  charge  of  gatherings  of  like  sort,  the 
vaccination  of  people  under  their  charge. 

If  an  outbreak  of  smallpox  occur  a  public  vaccination 
station  should  be  established  where  at  stated  hours  all 
who  apply  can  be  vaccinated  free. 


170  PUBUC   HEALTH   MANUAL 

Vaccine  vims. —  The  Public  Health  Law  requires  that 
a  suitable  supply  of  vaccine  virus  shall  be  provided  at 
stated  intervals  by  the  board  of  health  of  a  quality  and 
from  a  source  approved  by  the  State  Department  of 
Health,  and  that  during  an  actual  epidemic  of  smallpox 
it  shall  obtain  fresh  supplies  of  such  virus  at  intervals 
not  exceeding  one  week,  and  at  all  times  provide  safe 
and  thorough  vaccination  for  all  persons  in  need  of  the 
same.  The  virus,  if  from  a  bovine  source,  should  be 
glycerinated,  fresh,  kept  in  a  dry  cool  place  and  dis- 
tributed freely. 

Care  of  vaccination. —  If  good  virus  is  properly  intro- 
duced and  the  abrasion  and  sore  protected  from  infec- 
tion, vaccination  will  be  robbed  of  all  reasonable  dis- 
favor. The  person  should  be  clean  and  clad  in  clean 
clothes.  The  process  should  be  regarded  as  a  minor 
surgical  operation,  in  the  performance  of  which  the 
same  scrupulous  care  should  be  taken  and  proper  after 
treatment  administered.  The  responsibility  rightly  rests 
on  the  operator,  whose  hands,  instruments  and  methods 
must  be  surgically  clean. 

After  the  little  wound  has  dried  it  should  be  cov- 
ered with  a  sterilized  dressing  and  a  fresh  one  applied 
after  two  or  three  days.  Children  should  be  kept 
from  handling  it  and  from  playing  in  dusty  streets  or 
in  the  soil,  and  their  bodies  should  be  kept  clean.  No 
ointment  should  be  allowed,  and  nothing  except  clean 
boiled  water  applied  to  the  sore.  People  should  know 
that  practically  every  "  bad  arm  "  is  due  to  dirt  enter- 
ing the  lesion  after  the  vaccination.  The  use  of  shields 
to  cover  the  vaccination  is  objectionable,  at  least  after 
the  first  day  or  two. 

As  to  technique  the  skin  should  be  made  surgically 
clean,  the  abrasion  should  be  made  with  as  little 
trauma    as    possible    at    the    insertion    of    the    deltoid 


SMAILPOX  171 

muscle  or  an  incli  or  more  atove  it  on  the  outer  edge 
of  the  muscle;  not  over  a  muscle,  unless  in  infants, 
where  for  cosmetic  purposes  it  may  be  done  higher  on 
the  arm.    It  is  best  made  by  parallel  linear  scratches. 

Circular  on  smallpox.— The  Stat-e  Department  of 
Health  issues  a  circular  on  smallpox  for  free  distribu- 
tion in  households  where  the  disease  exists,  among  the 
occupants  of  neighboring  houses  and  others  when  needed. 

A  pamphlet  on  vaccination,  the  object  of  which  is  to 
instruct  school  authorities  and  other  influential  persons 
in  the  community  on  this  important  subject,  has  been 
prepared  by  the  Department,  and  will  be  sent  on  appli- 
cation. 

There  is  also  issued  a  leaflet  on  care  of  va-ccination 
which  should  be  provided  and  given  to  every  vaccinated 
household  with  instructions  for  its  careful  perusal  and 
strict  observance. 

The  smallpox  house. —  When  smallpox  is  discovered  in 

a  house  the  health  officer  should  insist  on  the  vaccina- 
tion of  all  the  unvaccinated  persons  found  there,  and 
the  reva.ccination  of  all  but  those  who  have  been 
recently  successfully  vaccinated.  They  should  be  kept 
under  observation,  if  necessary  by  quarantine,  until  suc- 
cessful vaccination  is  assured,  or  otherwise,  durinsr  the 
period  of  incubation  of  smallpox.  If  it  is  impossible 
to  remove  the  patient  from  the  premises,  an  absolute 
quarantine  which  will  include  attendants  and  inmates 
who  remain  must  be  established.  The  rules  to  guide 
health  officers  in  the  maintenance  of  a  suitable  quaran- 
tine are  given  in  the  Sanitary  Eegulations  printed  else- 
where in  this  Manual.  Until  the  people  learn  to  pro- 
tect themselves  by  vaccination,  the  rigid  quarantine  of 
smallpox  must  be  enforced. 


I 


172 


PUBLIC   HEALTH   MANUAL 


Neighborhood  vaccination.— The  health  officer  should 
urge  the  occupants  of  the  houses  in  the  two  blocks  in 
the  vicinity  of  the  smallpox  house  to  be  vaccinated  or 
revaccinated,  as  shown  in  the  accompanying  diagram: 


SMAILPOX  173 

In  many  cases  a  general  house  to  house  vaccination 
is  desirable,  and  has  been  found  very  effective. 

If  the  smallpox  patient  has  recently  been  employed 
in  a  store  or  factory  or  with  any  assembly  of  people, 
the  health  oflBcer  should  endeavor  to  secure  the  vacci- 
nation of  all  such  persons  exposed. 

Isolation  hospital. —  Smallpox  is  best  handled  by  re- 
moval of  the  sick  to  an  isolation  hospital,  especially 
■when  many  cases  exist.  The  removal  would  not  be 
necessary  if  everyone  icould   te  vaccinated. 

Should  there  be  no  regular  isolation  hospital,  any  iso- 
lated building,  if  suitable  for  occupancy,  could  be  made 
to  answer  the  purpose  for  a  few  cases,  or  a  temporary 
structure  which  will  answer  every  piu-pose  can  be 
quickly  erected,  or  in  warm  weather  a  tent  could  be 
used  to  an  excellent  advantage. 

Duration  of  quarantine. —  This  should  be  maintained 
for  three  weeks  or  until  the  skin  is  clear.  As  soon  as 
desquamation  has  been  completed  the  patient  should 
be  given  a  warm  bath,  special  attention  being  given  to 
the  hair  and  soles  of  feet.  He  should  then  be  given  a 
complete  change  of  uninfected  clothing.  If  there  are  no 
other  cases  of  smallpox  in  the  house  it  may  be  disin- 
fected at  once,  according  to  the  rules  given  in  the  cir- 
cular on  disinfection  of  the  State  Department  of  Health. 

Support  and  aid  for  persons  in  quarantine. —  When  a 
family  is  quarantined  for  smallpox  or  other  contagious 
disease  the  board  of  health  is  bound  to  secure  for  them 
all  the  necessaries  of  life,  including  medical  aid  and 
nurses  when  needed.  The  expenses  thus  incurred  are 
to  be  paid  by  the  family  when  able  to  do  so;  when 
not,  by  the  municipality. 


174  PUBLIC   HEALTH    MANUAL 

The  same  rule  applies,  legally,  at  least,  when  property 
is  destroyed,  as  in  burning  infected  bedding  or  clothing, 
which,  save  for  comparatively  worthless  things,  is  need- 
less. It  should  always  be  considered,  however,  that  such 
destruction  of  property  is  for  the  protection  of  the 
public  and  not  for  the  benefit  of  the  family.  Boards  of 
health  may  furnish  to  quarantined  families  everything 
needed  without  delaj^,  allowing  the  question  as  to  who 
is  to  pay  to  be  settled  afterwards. 

In  case  of  death. —  The  attention  of  sanitary  author- 
ities is  called  to  the  last  rule  in  the  circular  on  small- 
pox issued  by  the  State  Department  of  Health  for  house- 
hold distribution.  This  relates  to  the  precautions  to 
be  taken,  if  a  case  terminates  fatally,  and  health  au- 
thorities should  see  that  the  rule  is  strictly  carried  out, 
and,  if  necessary,  take  charge  of  the  funeral  arrange- 
ments, to  make  certain  that  it  is  private. 


DIPHTHERIA  175 


DIPHTHERIA 

All  cases  to  be  reported. —  Diphtheria  is  a  dangerous 

communicable  disease,  cases  of  which  must  be  reported 
at  once  by  attending  physicians  to  health  officers  and 
local  boards  of  health,  who  should  immediately  notify 
the  State  Department  of  Health  of  the  cases.  Special 
blanks  for  this  purpose  are  supplied  by  the  Department. 
Too  much  stress  cannot  be  laid  on  the  importance  of 
properly  handling  the  first  case  of  diphtheria.  When 
this  is  done  an  outbreak  of  the  disease  can  generally 
be  averted.  The  prompt  suppression  of  the  first  case 
should  be  the  aiin  of  the  health  oificer. 

Circular  on  diphtheria. —  The  State  Department  of 
Health  has  issued  a  circular  on  diphtheria  for  free  dis- 
tribution in  households  where  the  disease  occurs.  The 
circular  gives  some  general  information  about  the  dis- 
ease, suggests  precautions  against  its  spread,  and  lays 
down  a  number  of  rules  to  be  observed  by  parents  and 
nurses.  The  health  officer  should  familiarize  himself 
with  the  contents  of  this  circular,  and  should  see  that 
a  copy,  or  explicit  information  and  instruction  of  like 
character,  reaches  every  household  from  which  a  case 
of  diphtheria  is  reported.  School  teachers  should  also 
be  supplied  with  them  so  that  they  may  aid  in  con- 
trolling the  disease  by  exclusion  of  suspected  cases. 

Diagnosis  from  cultures. —  The  State  Hygienic  Labora- 
tory is  prepared  to  aid  in  the  diagnosis  of  doubtful  cases 
by  the  bacteriological  examination  of  cultures  taken 
from  the  throat. 

The  Klebs-Loeffler  or  diphtheria  bacillus  is  present  in 
the  membranes  and  secretions  of  the  mouth,  nose  and 
throat  of  cases  of  diphtheria.     The  only  certain  sign  of 


176  PXJBLIC   HEALTH    ^MANUAL 

the  existence  of  the  disease  is  the  determination  of  the 
presence  of  the  bacilli  in  a  culture  from  these  secretions. 
Culture  tubes  are  supplied  by  the  State  Department 
of  Health  for  this  purpose  on  request.  They  should  be 
kept  on  hand  for  use  in  every  case  of  suspected  diph- 
theria, for  determining  the  release  of  the  patient  from 
quarantine,  and  for  the  detection  of  bacilli  carriers,  and 
in  possible  secondary  cases;  or  where  a  new  case  of 
diphtheria  is  suspected  in  a  community.  It  should  be 
remembered,  however,  that  these  tubes  remain  in  good 
condition  for  a  month  or  two  only  without  drying  up. 

Diphtheria  bacilli  in  healthy  throats. —  In  families  or 
institutions  where  diphtheria  exists  or  has  existed,  some 
healthy  persons  often  harbor  the  specific  bacilli  in  the 
throats.  Some  of  these  develop  the  disease  later;  some 
may  transmit  the  disease  to  others ;  but  most  do  neither. 
All  throats  or  nasal  passages  harboring  the  germs  of 
diphtheria  are  a  menace  to  the  health  of  others,  especi- 
ally children,  and  +hose  who  harbor  the  germs  should 
be  carefully  isolated  and  treated  until  they  disappear. 

Diphtheria  and  tonsilitis. —  During  epidemics  of  diph- 
theria exudative  inflammations  simulating  benign  ton- 
silitis are  often  seen,  which  would  not  be  regarded  as 
diphtheria  were  it  not  for  a  history  of  contact  with  the 
disease.  Such  cases  should  be  isolated  and  the  usual 
precautions  enforced,  and  a  bacteriological  test  should 
be  made. 

Virulence  of  bacilli  in  convalescence. —  Long  persist- 
ence in  the  throat  does  not  lessen  the  virulence  of  diph- 
theria bacilli;  yet  an  acute  case  of  diphtheria  is  more 
dangerous  than  a  convalescent  case  in  which  the  bacilli 
exist  because  the  secretions  are  more  abundant,  there 
are  more   diphtheria  bacilli,   and,   in   malignant  cases. 


DIPHTHEEIA  ■  177 

other  pathogenic  bacteria  (streptococci,  etc.)  aid  them 
in  gaining  a  foothold.  Investigations  have  shown  that 
in  about  25  per  cent,  of  all  cases  the  diphtheria  bacillus 
persists  in  the  throat  for  three  weeks  or  longer  after 
the  beginning  of  the  disease;  in  15  per  cent,  for  four 
weeks  or  longer;  in  5  per  cent  for  five  weeks  or  longer, 
and  occasionally  for  months.  All  persons  convalescent 
from  diphtheria  must  remain  separate  from  others,  until 
cultures  from  the  throat  taken  on  two  successive  days 
show  the  absence-  of  diphtheria  bacilli.  Thev  should  be 
required  to  take  proper  precautions  with  regard  to  their 
secretions,  and  particularly  to  avoid  intimacy  with 
children. 

Isolation  and  quarantine. —  The  patient  must  be  iso- 
lated from  the  rest  of  the  family  and  quarantine  should 
be  enforced.  Children  and  school  teachers  in  the  same 
house  should  not  be  permitted  to  attend  school  until  the 
case  is  terminated  and  all  possible  danger  removed- 
Such  children  should  not  be  allowed  to  play  with  the 
members  of  other  households.  The  attention  of  the 
health  ofiicer  is  drawn  to  rule  11  in  the  circular  on 
diphtheria  issued  by  the  State  Department  of  Health 
for  household  distribution,  which  reads: 

"  Unless  it  is  absolutely  certain  that  such  precautions 
are  taken  as  will  prevent  the  spread  of  the  disease,  the 
health  officer  or  board  of  health  may  order  that  during 
the  illness  no  occupation  of  any  kind,  as  tailoring, 
laundering,  manufacturing  of  cigars  or  other  merchan- 
dise can  be  permitted  in  the  apartment  or  house  occu- 
pied by  the  family,  and  that  cases  in  a  room  conne<!ted 
with  a  store  or  in  a  farmhouse  where  dairy  produce  is 
sold,  must  either  be  removed  to  a  hospital  or  the  store 
must  be  closed  or  the  sale  of  dairy  produce  be  stopped 
vntil  after  the  final  disinfection  has  been  performed.'' 
12 


178  PUBLIC  HEALTH   MANUAL 

The  object  of  this  rule  is  to  prevent  any  possible  con- 
tact between  bacilli-carrying  attendants  or  members  of 
the  household  and  outsiders  or  the  carrying  out  of  the 
house  of  infected  material  of  any  kind. 

Immunization. — As  it  has  been  proved  that  antitoxrin 
will  protect  persons  who  have  been  exposed  to  diphtheria 
from  contracting  the  disease,  the  State  Department  of 
Health  strongly  recommends  the  use  of  immunizing 
doses,  1,000  units,  of  antitoxin  when  there  has  been  ex- 
posure to  diphtheria,  and  to  all  children  in  families 
in  which  the  disease  occurs. 

Curative  doses  of  antitoxin. —  The  State  Department 
of  Health  emphatically  recommends  the  ea/rly  use  oi 
antitoxin  in  every  case  of  diphtheria.  When  freely 
given  during  the  first  twenty-four  hours  of  the  disease, 
antitoxin  saves  96.4  per  cent  of  all  cases.  Full  instruc- 
tions for  administration  accompany  each  package  seni 
out  by  the  Department  and  should  be  carefully  followed. 

Disinfection. —  Disinfection  of  the  discharges  and  of 
the  bedding  and  clothing  is  very  important.  Suggestions 
regarding  the  methods  to  be  used  will  be  found  in  the 
circular  on  diphtheria  issued  by  the  State  Department 
for  household  distribution  and  in  the  special  circular  oi 
disinfectants  and  disinfection. 

Free  antitoxin. —  The  State  Hygienic  Laboratory  fur- 
nishes antitoxin  free  for  use  in  families  where  it  oould 
not  otherwise  be  obtained.  The  ipolicy  of  the  State  De- 
partment of  Health  favors  the  liberal  employment  of 
antitoxin.  In  all  emergency  cases,  or  where  there  may 
be  a  question  as  to  the  family  obtaining  the  remedy, 
never  hesitate,  hut  use  it  freely.  Our  one  aim  is  to  sav^e 
the  patient  and  prevent  the  spread  of  the  disease.     The 


DIPHTHERIA  179 

physician  or  health  officer  who  uses  State  antitoxin  must 
make  a  report  of  the  case  on  blanks  issued  by  the  De- 
partment. 

Release  from  quarantine. — ^As  already  stated,  no  case 
of  diphtheria  should  be  discharged  from  quarantine  un- 
til twenty-one  days  have  elapsed  since  the  beginning  of 
the  disease,  and  only  then  if  two  successive  cultures 
made  three  days  apart  show  no  diphtheria  bacilli. 
Where  the  diphtheria  germ  persists  in  its  prevalence 
in  the  throat  of  a  patient,  giving  no  clinical  symptoms, 
the  State  Department  of  Health  must  be  informed  and 
the  case  be  made  one  for  special  investigation  by  the 
Department. 

In  case  of  death. —  The  attention  of  sanitary  author- 
ities is  drawn  to  the  last  rule  in  the  circular  on  diph- 
theria issued  by  the  State  Department  of  Health  for 
household  distribution.  This  relates  to  the  precautions 
to  be  taken  if  a  case  terminates  fatally,  and  health  au- 
thorities should  see  that  the  rule  is  carried  out,  and  if 
necessary,  take  charge  of  the  funeral  arrangements. 


180  PUBLIC    HEALTH    MANUAL 

CEREBROSPINAL  MENINGITIS 

All  cases  to  be  reported. —  Cerebrospinal  meningitis  is 
a  very  fatal  infectious  disease,  all  cases  of  whicli  must 
be  reported  by  the  attending  physicians  to  the  local 
health  officer  or  board  of  health,  Avho,  in  turn,  should 
notify  the  State  Department  of  Health  within  twenty- 
four  hours.  Blanks  are  provided  by  the  Department  for 
the  making  of  these  reports. 

Circulars  on  cerebrospinal  meningitis. —  The  State  De- 
partment of  Health  has  issued  a  circular  on  cere- 
brospinal meningitis  for  gratuitous  distribution,  es- 
pecially in  households  where  cases  of  cerebrospinal  men- 
ingitis exist.  This  circular  gives  some  general  informa- 
tion expressed  in  language  as  little  technical  as  possible 
as  to  the  cause  of  the  disease  and  the  chief  sources  of 
infection,  and  enumerates  the  duties  of  parents  and 
nurses  having  charge  of  patients  sick  with  the  disease. 
These  can  be  obtained  from  the  Department  in  any 
quantity,  and  health  officers  should  seek  the  co-operation 
of  the  attending  physician  in  seeing  that  this  circular, 
or  explicit  information  and  instruction  of  like  character, 
is  put  in  the  hands  of  the  heads  of  families  visited  by 
the  disease.  The  health  officer  should  also  familiarize 
himself  with  its  contents,  and,  as  far  as  practicable,  en- 
force the  rules  laid  down  in  it.  In  times  of  epidemic, 
the  circular  should  be  widely  distributed. 

Germs  in  healthy  throats. —  The  specific  germ  of  epi- 
demic cerebrospinal  meningitis  is  sometimes  found  in  the 
throats  and  noses  of  healthy  persons  who  have  come 
in  contract  with  persons  suffering  from  the  disease,  or 
who  have  used  handkerchiefs  or  towels  soiled  by  such. 
These  people  may  transmit  the  disease  to  others,  even 
though  they  remain  well  themselves.     Hence  the  import- 


CEEEBBOSPINAL   MENINGITIS  181 

ance  of  isolation  and  the  exercise  of  great  care  in  the 
management  of  the  disease. 

Spinal  fluid  examination. — An  absolute  proof  that  a 
suspected  case  is  one  of  epidemic  cerebrospinal  menin- 
gitis is  furnished  by  the  finding  of  the  special  germ  in 
the  spinal  fluid  withdrawn  from  the  spinal  column  by  a 
hypodermic  needle.  This  is  a  simple  procedure,  and 
when  carried  out  under  proper  aseptic  precautions,  is 
devoid  of  danger.  The  withdrawal  of  some  of  the  spinal 
fluid  is  often  of  great  benefit,  relieving  some  of  the 
pressure  symptoms.  Health  ofiicers  should  therefore 
urge  this  measure  upon  attending  physicians. 

Diagnosis. —  The  course  of  the  disease  is  usually  acute, 
often  starting  with  repeated  chills,  not  rarely  preceded 
by  coryza  and  followed  by  fever  and  disturbances  calling 
attention  to  implication  of  the  brain  and  spinal  cord, 
such  as  vertigo,  intense  headache,  rigidity  of  the  back 
of  the  neck  and  opisthotonos,  and  in  grave  cases  coma; 
herpes  is  common.  Kernig's  symptoms  aid  diagnosis, 
and  as  noted  the  diagnosis  is  assured  by  finding  the 
meningococcus  in  the  spinal  fluid.  Its  severity  varies 
much  in  epidemics.  Its  course  is  more  fulminant  than 
that  of  tubercular  meningitis  and  it  attacks  robust  sub- 
jects. It  is  a  disease  of  childhood  and  early  life,  oc- 
curring in  winter  and  spring,  and  epidemics  are  limited 
to  small  districts.  Infantile  paralysis  is  likewise  a  dis- 
ease of  childhood  but  occurs  in  midsummer  and  early 
fall,  and  is  a  rather  abrupt  fever  with  paralysis  of  the 
lower  limbs  soon  or  after  several  days. 

Isolation  and  quarantine. —  The  patient  must  be  iso- 
lated from  the  rest  of  the  family  and  quarantine  should 
be  enforced  for  at  least  the  first  two  weeks  of  the  illness. 
Children  and  school  teachers  in  the  same  house  should 


182  PUBLIC  HEALTH   MANUAL 

not  be  permitted  to  attend  school  until  the  case  is  termi- 
nated. Such  children  should  not  be  allowed  to  play 
with  members  of  other  households.  The  attention  of  the 
health  officer  is  drawn  to  rule  11  in  the  circular  on 
cerebrospinal  meningitis  issued  by  the  State  Department 
of  Health  for  household  distribution,  which  reads: 

"  Unless  it  is  absolutely  certain  that  such  precautions 
are  taken  as  will  prevent  the  spread  of  the  disease,  the 
health  officer  or  board  of  health  may  order  that  during 
the  illness  no  occupation  of  any  kind,  as  tailoring, 
laundering,  manufacturing  of  cigars  or  other  merchan- 
dise can  be  permitted  in  the  apartment  or  house  occu- 
pied by  the  family,  and  that  cases  in  a  room  connected 
with  a  store  or  in  a  farmhouse  where  dairy  produce  is 
sold,  must  either  be  removed  to  a  hospital  or  the  store 
must  be  closed  or  the  sale  of  dairy  produce  be  stopped 
until   after  the  final   disinfection  has  been  performed." 

The  object  of  this  rule  is  to  prevent  any  possible  con- 
tact between  bacilli-carrying  attendants  or  members  of 
the  household  and  outsiders  or  the  carrying  out  of  the 
house  of  infected  material  of  any  kind. 

In  the  district  where  an  epidemic  of  cerebrosipinal 
meningitis  is  present  gatherings  of  people  in  assembly 
should  be  prevented. 

Disinfection. —  Disinfection  of  the  discharges  and  of 
the  bedding  and  clothing  is  very  important,  and  especial 
care  must  be  taken  with  secretion  from  the  nose, 
bronchial  tubes  and  possible  discharges  from  the  ears. 
Suggestions  regarding  the  methods  to  be  used  will  be 
found  in  the  circular  on  cerebrospinal  meningitis  issued 
by  the  State  Department  for  household  distribution  and 
in  the  special  circular  on  disinfectants  and  disinfection. 

In  case  of  death. —  The  attention  of  sanitary  author- 
ities is  drawn  to  the  last  rule  in  the  circular  on  cere- 


CEEEBEOSPINAL   MEIS^INGITIS  183 

brospinal  meningitis  issued  by  tlie  State  Department  of 
Health  for  household  distribution.  This  relates  to  the 
precautions  to  be  taken  if  a  case  terminates  fatally,  and 
Health  authorities  should  see  that  the  rule  is  strictly 
carried  out,  and  if  necessary,  take  charge  of  the  funeral 
arrangements. 


184  PUBLIC   HEALTH    MANUAL 


EPIDEMIC    POLIOMYELITIS 

(Infantile  Paralysis) 

All  cases  to  be  reported. —  The  evidence  that  this 
disease  is  communicable  has  accumulated  to  such  de- 
gree, with  the  probability  that  continued  observation 
will  add  proof  to  this,  that  it  is  therefore  placed  among 
those  diseases  which  must  be  reported  to  health  ofl&cers 
and  to  the  State  Department  of  Health.  Its  subjects 
must  likewise  be  isolated  from  the  public  and  exposTire 
to  it  must  be  guarded  against. 

Its  epidemic  prevalence. —  Acute  Anterior  Poliomye- 
litis is  not  a  new  disease,  for  it  has  for  many  years 
been  recognized  as  a  distinct  affection.  Its  cases  have, 
however,  been  comparatively  few  and  sporadic,  and  it 
is  only  in  recent  time  that  epidemic  tendencies  have 
attracted  attention  and  that  conviction  of  its  having  a 
quality  of  infection  has  taken  form. 

Its  records  show  three  significant  characteristics: 
that  while  infrequent  its  prevalence  has  been  for  years 
increasing;  that  it  has  been  having  a  wider  distribution 
throughout  the  world ;  and  especially,  that  it  has  been 
occiu-ring  epidemically. 

In  a  compilation  for  the  Massachusetts  State  Board 
of  Health,  Lovett  finds  a  record  of  an  increasing  num- 
ber of  epidemics  and  of  cases  in  each  succeeding  five- 
year  period  since  1880,  and  to  some  extent  an  increase 
in  the  number  of  cases  to  the  epidemic.  In  the  last 
twenty  years  there  were  in  the  literature  of  the  world 
61  outbreaks  with  8,900  cases;  and  in  the  last  quin- 
quenium  there  were  more  than  8,000  cases  in  25  epi- 
demics, th  average  number  of  cases  to  the  outbreak 
being  much  greater  than  had  been  previously  recorded. 


EPIDEMIC    POLIOMYELITIS  185 

In  1905  the  disease  became  very  prevalent  in  Scandi- 
navia, with,  numerous  outbreaks  in  scattered  localities; 
there  appears  to  have  spread  thence  a  wave  of  infection 
and  it  has  developed  into  a  general  pandemic.  Prior 
to  1907  this  disease  was  rare  in  this  country;  in  1907 
epidemics  of  remarkable  proportion  developed  at  Bos- 
ton and  about  Xew  York,  places  where  immigrants  are 
most  concentrated,  and  the  following  year  in  Minne- 
sota, Kansas  and  States  sought  by  immigrants  from 
Sweden  and  northern  Europe.  Of  the  8,000  cases  for 
the  years  1905-9  on  record,  5,000  occurred  in  this 
country,  ail  practically  within  the  last  three  years  of 
the  period. 

In  1910  the  disease  spread  over  the  coimtry,  having 
been  reported  to  the  Surgeon-general  of  the  Marine 
Hospital  Service  from  23  States,  and  it  has  been  esti- 
mated that  not  less  than  3,000  cases  have  occurred. 
In  this  State  no  outbreak  has  occurred  in  recent  time 
outside  that  of  New  York  in  1908  and  one  in  St.  Law- 
rence county  in  1909;  during  1910  there  have  b€en  227 
cases  from  47  counties  reported  to  the  Stat€  Depart- 
ment of  Health.  Its  history  shows  a  progressive  in- 
crease in  the  prevalence  and  epidemic  character  of  the 
disease. 

An  infectious  disease.-— That  it  is  due  to  living 
germs  is  evident  from  its  pandemic  spread;  this  fact 
has  been  further  established  by  Flexner,  who,  although 
he  has  not  found  visually  the  special  organism  because 
of  its  minuteness,  has  transmitted  the  disease  to  the 
monkey  in  such  a  way  as  to  demonstrate  the  fact  of 
its  existence.  There  are  other  infectious  diseases  whose 
disease-germ  has  also  as  yet  evaded  ocular  detection. 
Immimitv  appears  to  be  secured  by  one  attack.  The 
virus  has  been  demonstrated  in  the  spinal  cord  and 
brain,  in  the  glands  and  nasal  mucous  membrane. 


186  PUBLIC   HEALTH   MANUAL 

How  it  is  contracted. —  Epidemiological  studies  have 
been  to  some  extent  convincing  that  the  disease  is 
spread  by  direct  contact  with  the  sick,  and  also  that 
it  may  be  conveyed  by  healthy  persons  who  have  been 
in  contact  with  the  sick.  The  human  body  is  the 
breeding-place  for  its  micro-organism,  and  it  is  quite 
safe  to  say  that  it  is  communicable,  absence  of  evi- 
dence of  this,  reported  by  some  observers,  being  doubt- 
less due  in  part  to  a  varying  degree  of  infectivity  in  dif- 
ferent epidemics;  there  is  too  a  varying  and  indeed 
low  degree  of  susceptibility  to  it  even  among  the  young 
children  who  are  its  chief  subjects. 

How  its  virus  finds  exit  from  the  body  is  so  far 
known  that  its  existence  in  the  discharges  from  the  nose, 
mouth  and  throat  has  been  detected,  and  it  is  suspected 
to  exist  in  the  other  excreted  matter  of  the  body.  Ma- 
terial soiled  with  any  of  these  discharges  will  probably 
be  infective  for  a  time.  Holt  instances  the  taking  of 
the  disease  by  a  child  brought  from  a  healthy  neighbor- 
hood which  was  put  to  sleep  in  the  crib  of  an  affected 
child. 

The  virus  finds  entrance  to  the  body  as  would  seem 
probable  through  the  respiratory  tract,  by  inhalation 
of  infected  air,  contaminated  dust  or  particles  of  in- 
fected matter  given  off  from  the  patient.  It  is  not  con- 
veyed through  food  or  water.  The  incubation  period  is 
generally  within  ten  days. 

Nature  of  the  disease.—  Its  outbreaks  affect  a  limited 
area.  It  extends  peripherially  from  a  central  focus 
over  the  infected  district.  It  is  not  a  disease  of  insti- 
tutions or  asylums,  nor  especially  of  tenement-house 
districts;  rather  of  the  open  country  and  among  healthy 
subjects.  It  prevails  mostly  in  temperate  and  cold 
regions.  Epidemics  occur  from  July  to  October.  Epi 
demies  are  not  followed  in  succeeding  seasons  by  spo    i 


EPIDEMIC    POLIOMYELITIS  187 

radio  cases,  so  it  does  not  appear  to  become  implanted 
in  a  locality  by  persisting  virus. 

Clinically,  it  is  nearly  always  ushered  in  with  fever 
(100-104),  lasting  from  three  to  seven  days,  accom- 
panied by  malaise  and  nervous  irritability,  which  latter 
may  precede  fever  by  several  days.  Pain  in  the  head, 
neck  and  down  the  legs,  muscular  twitching,  and  sensi- 
tiveness when  handled  are  among  the  nervous  symp- 
toms; while  in  severe  cases  there  may  be  rigidity  of 
the  neck,  with  sweating,  prostration  and  vomiting. 
Gastro-intestinal  disturbance  is  commonly  present, 
either  diarrhea  or  constipation.  Following  these  onset 
symptoms  a  flaccid  motor  paralysis  of  the  extremities 
occurs,  involving  a  group  of  muscles;  this  reaches  its 
maximum  in  three  or  four  days,  and  in  a  week  or  ten 
days  improvement  begins  and  continues  till  but  a  small 
amoiuit  remains,  of  the  leg  muscles  generally,  which  is 
usually  permanent.  On  the  other  hand  the  gi'eater  part 
of  the  muscles  originally  affected  may  remain  paralyzed. 

The  disease  is  however  protean  in  its  manifestations 
and  the  classical  symptoms  are  not  always  followed. 
The  paralysis  may,  though  rarely,  be  the  first  symptom 
noticed,  a  healthy  child  being  suddenly  found  to  have 
lost  the  use  of  one  or  more  extremities.  Abortive 
cases  occur  in  which  there  is  no  paralysis.  The  nervous 
phenomena  vary  according  to  the  region  of  the  nerve 
centers  attacked. 

The  disease  is  an  infectious  fever  with  inflammation 
of  the  anterior  horns  of  the  spinal  cord;  of  the  men- 
inges, the  medulla,  and  even  the  brain  itself  in  severe 
cases,  the  type  varying  as  parts  in  individual  cases  are 
affected. 

Mortality  is  not  great;  it  has  been  put  at  an  average 
of  five  per  cent,  though  in  some  epidemics  it  has  been 
higher.  But  a  large  proportion  of  those  who  escape 
with  their  lives   are   left  with  a  permanent   disability 


188  PUBLIC   HEALTH   MAKTTAL 

which  often  results  in  a  lifetime  of  dependence,  an  epi- 
demic leaving  in  its  wake  cripples  to  the  next  genera- 
tion. 

Its  diagnosis. —  Cases  showing  symptoms  referable  to 
the  central  nervous  system  are  distinctive  enough  to 
make  a  clinical  diagnosis  possible.  Others  with  symp- 
toms mainly  of  general  infection,  unless  having  relation 
to  typical  cases,  are  likely  to  be  overlooked.  Many  fail 
to  show  a  sharp  clinical  picture.  There  may  be  abortive 
cases  which  are  so  slight  as  not  to  be  brought  to  the 
attention  of  a  physician,  or  those  which  receive  the 
diagnosis  of  influenza,  muscular  rheumatism,  or  diar- 
rhea. The  differentiation  must  be  generally  from  cere- 
brospinal meningitis.  In  this  the  symptoms  are  more 
pronounced,  the  retraction  of  the  head  and  rigidity  of 
the  neck  more  marked,  and  there  is  absence  of  the 
paralysis  which  is  characteristic  of  poliomyelitis.  The 
idubjects  01  the  latter  are  for  the  most  part  under  five 
years  of  age;  it  is  a  disease  of  the  warm  months  in- 
stead of  the  cold.  Examination  of  the  cerebrospinal 
fluid  will  help  the  differentiation,  being  negative  in 
poliomyelitis.  In  sporadic  cases  the  nervous  phenomena 
if  present  will  attract  attention  to  this  disease.  Dur- 
ing an  epidemic  disturbances  along  the  general  line  of 
its  common  symptoms  will  be  heeded. 

Its  control. —  Recognizing  it  as  communicable,  the 
patient  should  be  isolated.  As  the  infection  can  be  in 
the  things  about  the  patient,  these  must  be  suitably 
controlled.  Regard  must  be  had  by  the  attendants  to 
the  fact  that  they  may  carry  infection.  All  discharges, 
especially  those  from  the  mouth  and  nose,  must  be  dis- 
infected and  suitably  disposed  of.  The  care  of  the  room 
and  the  house  should  be  such  that  dust  may  not  be  per- 
mitted  to   escape,   by   sprinkling  before   sweeping  and 


Epidemic  poliomyelitis  189 

the  use  of  damp  cloths.  The  good  of  the  patient  de- 
mands quiet,  rest  and  seclusion.  Every  care  must  be 
taken  that  no  one  from  outside,  especially  young  chil- 
dren, come  in  contact  with  the  sick  or  their  surround- 
ings. The  rules  for  quarantine  of  communicable  dis- 
eases should  in  all  respects  be  followed  throughout  the 
active  period  of  its  acute  stage,  probably  for  a  period 
of  three  or  four  weeks,  both  in  mild  and  well-marked 
cases. 

Infantile  Paralysis  is  likely  to  become  a  permanent 
feature  of  medical  work.  There  is  a  good  deal  to  learn 
yet  about  it,  of  a  sort  that  can  only  be  gained  in  the 
infected  area  and  at  the  bedside.  Health  oflQcers  can 
contribute  to  this  by  investigation.  Plotting  the  cases 
on  a  map,  locating  the  cases  and  the  date  of  onset,  the 
number  of  cases  in  the  house,  the  evidences  of  con- 
tagion, the  environment  of  the  case,  the  clinical  char- 
acteristics in  which  the  attending  physician  will  assist, 
tracing  sources  of  infection,  and  the  record  and  report 
of  all  the  phenomena  of  an  outbreak  will  furnish  ma- 
terial of  permanent  value  toward  the  study  of  this  seri- 
ous disease.  Forms  for  the  report  of  individual  cases 
have  been  sent  out  by  the  State  Department  of  Health. 
By  means  of  these  and  such  original  investigation  and 
field  work  as  may  be  done  by  health  officers  and  the 
medical  profession  working  with  them,  the  character- 
istics and  control  of  epidemic  poliomyelitis  will  be  de- 
termined more  completely. 


190  PUBLIC  HEALTH    MANUAt 

MEASLES  AND  SCARLET  FEVER 

All  cases  to  be  reported. —  Measles  and  scarlet  fever 

are  communicable  infectious  diseases,  all  eases  of  which 
must  be  promptly  reported  by  the  attending  physicians 
to  the  local  health  officer  or  board  of  health,  who  in 
turn  should  notify  the  State  Department  of  Health 
within  twenty-four  hours.  Blanks  are  provided  by  the 
Department  on  which  to  make  these  reports.  In  the 
case  of  measles,  if  it  becomes  extensively  prevalent, 
the  individual  report  of  cases  to  the  Department  is  not 
necessary,  but  health  officers  should  report  the  number 
of  cases  and  keep  the  Department  well  informed  of  the 
progress  of  the  epidemic. 

Circulars  on  measles  and  scarlet  fever. —  The  State 

Department  of  Health  has  issued  circulars  on  measles 
and  scarlet  fever,  respectively,  for  gratuitous  distribu- 
tion, especially  in  households  where  either  of  these  dis- 
eases may  exist.  They  contain  general  information, 
expressed  in  language  as  little  technical  as  possible,  as 
to  the  sources  of  infection,  precautions  against  the 
spread  of  these  diseases,  and  the  duties  of  parents  and 
nurses  who  have  charge  of  such  cases. 

Every  health  officer  should  keep  himself  well  supplied 
with  this  literature  for  liberal  distribution  in  every  out- 
break of  either  measles  or  scarlet  fever.  He  should  seek 
the  oo-operation  of  the  attending  physician,  the  local 
physicans,  educational,  religious,  municipal  and  other 
agencies  to  insure  such  a  campaign  of  education  in  pre- 
ventive measures  that  these  diseases  may  receive  the 
energetic  suppressive  measures  which  their  gravity 
should  demand. 

The  health  officer  should  familiarize  himself  with  the 
contents  of  these  circulars  and  enforce  the  rules  and 
regulations  therein  laid  down. 


MEASIES  AXD  S CABLET  FEYEE  191 

Measles  a  dangerous  disease.— Health  officerg  should 
take  every  occasion  to  combat  the  popular  and  fallacious 
idea  that  measles  is  a  trifling  disease  which  every  child 
must  pass  through. 

As  stated  in  the  circular  on  measles,  above  mentioned, 
mortality  records  show  that  more  children  under  two 
years  of  a^ge  die  from  measles  than  from  any  other  con- 
tagious disease.  It  is  also  the  frequent  forerunner  of 
Dther  serious  diseases,  such  as  pneumonia,  plem-isy, 
tuberculosis,  paralysis,  meningitis,  and  many  others, 
which  emphasises  the  importance  of  so  caring  for  every 
3ase  that  if  possible  other  children  will  not  be  exposed. 

Young  children  should  always  be  protected  from  ex- 
[>osure  to  measles,  and  persons  in  feeble  health,  es- 
pecially those  having  pulmonary  disease,  nephritis, 
memia,  or  malnutrition. 

Scarlet  fever  is  accepted  by  the  people  as  a  disease  to 
3e  feared.  It  is  especially  important  that  children 
should  be  protected  from  it,  since  less  than  5  per  cent. 
di  the  cases  occur  after  the  age  of  fifteen  and  two- 
thirds  of  the  deaths  from  it  are  of  children  under  five 
fears  of  age. 

Diagnosis. —  Measles  is  readily  recognizable  after  the 
eruption  has  appeared,  but  it  is  important  to  guard 
igainst  it  early,  because  it  is  contagious,  to  some  degree 
:rom  the  beginning  of  the  initial  fever.  The  onset  o. 
,his  fever  is  gradual,  following  an  incubation  period  ol 
ibout  eleven  days,  with  coryza,  photophobia,  and  some- 
iimes  cough.  Koplik's  spots,  which  are  pathogno- 
nonic,  can  be  foimd  in  90  per  cent,  of  cases  as 
jmall  bluish  red  spots,  on  the  mucous  surfaces  of  the 
iheeks  and  other  parts  of  the  mouth,  from  one  to  three 
lays  before  the  skin  eruption.  When  measles  is  preva- 
ent  every  case  of  acute  coryza  ought  to  be  regarded  as 


122  PUBLIC   HEALTH   MANUAL 

suspicious.  The  eruption  on  the  skin  appears  on  the 
fourth  day,  as  slightly  raised  macules,  on  the  neck  and 
face,  increasing  in  amount  and  gradually  extending  over 
the  body,  fever  increasing  as  the  eruption  appears. 

Rubella,  German  measles,  is  sometimes  confused  with 
measles.  In  ordinary  outbreaks  it  has  a  short  initial 
fever,  with  moderate  or  no  coryza,  commonly  sore  throat. 
The  eruption  spreads  from  above  down  rapidly,  and 
fades  as  it  spreads.  The  post  cervical  glands  are  en- 
larged. It  occurs  as  an  epidemic  and  affects  children  i 
and  adults  and  those  who  have  had  measles. 

Scarlet  fever  is  most  difficult  of  diagnosis  in  mild 
cases.  Typical  cases  are  readily  recognizable,  but  no 
symptom  is  pathognomonic  and  simple  eruptive  affec- 
tions may  closely  reproduce  its  symptom- complex,  by 
which  it  has  to  be  judged,  though  often  indefinitely  ex- 
pressed. 

An  abrupt  onset,  with  vomiting;  disproportionately 
rapid  pulse ;  redness  of  the  uvula,  soft  palate  and  tonsils 
from  the  first;  some  degree  of  rash  after  twelve  or 
twenty-four  hours,  appearing  on  the  neck  and  spreading 
rapidly  to  the  face  and  chest,  will  generally  justify  a 
diagnosis  of  scarlet  fever.  The  lymph  glands,  especially 
the  cervical,  inguinal  and  axillary,  enlarge  early 
Desquamation  commences  where  the  eruption  first  ap- 
peared as  pin-head  rized  scale,  w4iich  enlarges  in  rings; 
the  most  typical  being  a  break  in  the  epidermis  which 
begins  under  the  free  border  of  the  nail. 

Mode  of  reception. —  Both  diseases  ordinarily  find  ac- 
cess to  the  system  through  the  upper  air  passages. 
With  scarlet  fever  an  infection  may  be  communicated 
through  cutaneous  wounds,  or  through  the  genital  tract 
in  puerperal  women,  which  should  be  borne  in  mind  by 
those  who  have  to  deal  with  this  disease. 


MEASXES  AXD  S  CABLET  FEVEB  193 

Measles  is  contagious  from  the  beginning  of  its  initial 
fever;  scarlet  fever  is  little  contagious  at  its  onset. 
The  discharges  from  the  nose  and  throat  are  the  chief 
carriers  of  infection  in  both;  those  from  the  ear,  from 
scarlatinal  otitis  media,  may  communicate  the  disease 
for  a  long  time. 

Measles  is  usually  contracted  by  direct  exposure  to 
the  sick,  and  its  contagium  is  short  lived,  so  that  it  is 
rarely  carried  avray  by  fomites  or  well  persons.  That 
of  scarlet  fever  is  long  lived,  and  the  disease  is  not  only 
communicated  by  contact  with  the  sick  but  may  be  long 
after  by  infected  articles.  It  may  also  be  conveyed  by 
milk  infected  through  proximity  to  the  disease. 

Isolation    and    quarantine. —  With   both   measles    and 

scarlet  fever,  as  vrith  any  communicable  disease,  much  of 
the  success  of  suppressing  a  threatened  outbreak  will  de- 
pend on  the  manner  in  which  the  first  case  is  handled. 
With  measles  the  sick  should  be  isolated  from  the  be- 
ginning of  the  fever  of  onset  until  the  ski] .  and  mucous 
surface  are  clear,  generally  for  three  weeks.  Well  mem- 
bers of  the  family  need  not  be  quarantined,  save  with 
certain  precautions  to  change  and  ventilate  their  cloth- 
ing before  mingling  with  other  people,  especially  chil- 
dren. Children  of  the  family  or  any  who  have  been  ex- 
posed must  be  excluded  from  school,  unless  they  have 
previously  had  the  disease,  A  quarantine  card  warning 
the  public  against  the  dangers  of  contagion  should  be 
placed  conspicuously  on  the  house. 

With  scarlet  fever  there  must  be  an  absolute  quaran- 
tine, with  complete  isolation  of  the  sick  and  the  nurse 
or  attendant,  as  far  as  possible,  from  other  members  of 
the  house.  When  possible  it  is  always  preferable  to 
remove  scarlet  fever  patients  at  once  to  an  isola- 
tion hospital,  which  will  insure  far  greater  protec- 
13 


194  PUBLIC   HEALTH   MANUAL 

tion  to  other  people.  Quarantine  should  include  those 
who  in  any  way  come  in  contact  with  the  sick,  as  they 
can  carry  the  infection  in  their  clothing,  or  on  articles 
which  they  might  take  away  from  the  sick  room  or 
house.  The  details  of  quarantine  care  may  be  found 
in  the  popular  circular  on  scarlet  fever.  Especial  at- 
tention should  be  given  to  rule  13,  which  prohibits  the 
occupation  of  laundering,  tailoring  or  manufacturing,  or 
the  handling  of  dairy  products,  exposure  of  milk  and 
milk  utensils  in  the  apartments  or  house  occupied  by  a 
family  in  which  scarlet  fever  exists.  Xeither  should  the 
milking  be  done  nor  the  utensils  cared  for  by  those  who 
in  any  way  came  in  contact  with  the  sick  or  infected 
articles. 

The  duration  of  the  quarantine  cannot  be  given,  as  it 
is  impossible  to  say  positively  when  the  infectivity  of 
all  cases  ceases.  "\"\Tiile  the  desquamating  scales  are 
not  necessarily  contagious,  it  is  a  good  rule  to  isolate 
the  patient  until  the  skin  is  clear.  It  is  most  important 
to  isolate  until  the  mucous  surfaces  are  clear. 

Disinfection. —  In  case  of  scarlet  fever,  the  destruction 
of  the  infection  on  every  article  about  the  sick  room  or 
premises  has  to  be  very  thorough.  It  should  be  done  or 
superintended  by  the  health  authorities,  who  should  fol- 
low the  instructions  given  for  this  purpose  on  the  cir- 
cular issued  by  the  Department  on  disinfection  and  dis- 
infectants. 

As  for  measles,  the  contagion  outside  the  body  of  the 
sick  is  short  lived,  and  beyond  the  destruction  of  it  on 
articles  soiled  with  discharges  from  the  mucous  passages, 
there  is  need  mostly  of  ventilation  with  fresh  air  and  of 
cleaning.  In  case  of  death,  the  attention  of  sanitary 
authorities  is  called  to  the  last  rule  in  the  circulars  for 
household  distribution. 


MEASLES  AND  S  CABLET  FEVEE  195 

Schools.—  Teachers  can  be  of  much  service  in  the  con- 
trol of  communicable  diseases.  This  is  especially  true 
of  measles,  with  its  early  contagiousness.  When  there 
is  an  epidemic  of  these  diseases  the  teachers  should  be 
well  informed  as  to  the  early  symptoms  attending  them, 
and  by  a  daily  inspection  all  of  these  early  cases  ouglit 
to  be  discovered  and  sent  from  school.  This  system, 
mergetically  pursued,  should  serve  nearly  as  well  as  a 
medical  school  inspector,  and  by  keeping  the  health 
officer  fully  informed  would  do  much  to  check  many 
an  outbreak  in  its  incipiency. 

This  is  one  of  the  most  important  measures  for  oon- 
:rolling  an  outbreak  of  measles,  the  difficulty  of  which 
s  enhanced  by  the  exposure  of  many  to  pre-eruptive 
jases.  Likewise  the  overlooked  cases  of  scarlet  fever 
nay  be  detected  by  the  existence  of  sore  throat,  or 
ven  by  commencing  desquamation. 

The  discovery  of  the  mild  or  ambulant  cases  may 
lo  much  in  checking  a  threatened  outbreak.  Clos- 
ng  the  schools  should  generally  be  a  last  resort 
a  the  management  of  infectious  diseases,  as  children 
mder  proper  vigilance  at  school  can  be  better  controlled 
han  at  home,  and  mild  cases  are  often  more  quickly 
liscovered  at  school  than  at  home  or  on  the  streets, 
should  a  case  of  infectious  disease  break  out  in  the 
choolroom,  disinfection  of  the  room  should  be  done 
mder  the  direction  of  the  health  officer  or  the  board 
f  health. 


196  PUBLIO  HEALTH  MANUAL 

WHOOPING  COUGH 

Whooping  cough  is  a  serious  disease. —  No  age  is  ex- 
empt from  it,  but  its  gravity  is  for  the  young.  Th( 
records  of  this  Department  for  twenty-five  years  shov 
that  in  this  State  there  has  been  an  average  yearly 
mortality  of  950,  that  of  measles  having  been  1,10( 
and  of  scarlet  fever  1,300.  Its  greatest  mortality  hai 
always  come  in  July  and  August.  Epidemics  vary  ii 
severity.  Its  fatality  always  depends  on  secondare 
complications. 

Young  children  are  most  likely  to  take  whoopini 
cough,  and  it  is  more  likely  to  be  fatal  with  them 
Almost  all  of  the  deaths  from  it  occur  under  the  ag 
of  five  years,  and  of  these  one-half  are  of  those  unde 
one  year  of  age.  The  average  age  at  death,  by  th 
United  States  census  reports,  is  one  and  one-hal 
years.  It  is  a  dangerous  disease  for  young  subjects 
For  all  it  is  a  distressing  disease;  when  severe,  last 
for  weeks  and  leaves  not  a  few  who  recover  in  a  stat 
of  chronic  invalidism  from  the  exhaustion  it  entails,  an 
with  heart  and  lung  changes  which  may  be  permanen' 
It  is  a  disease  which  by  all  means  should  be  avoide( 

It  begins  to  develop  from  four  to  fourteen  days  aft€ 
exposure.  For  the  first  few  days  the  symptoms  ai 
those  of  the  ordinary  cold  or  simple  catarrh,  but  wit 
less  fever  than  measles.  The  cough  which  attends  : 
is  out  of  proportion  to  any  lung  changes,  grows  harsh( 
and  after  a  week  or  ten  days  the  whoop  which  giv« 
it  its  name  and  by  which  it  is  recognized,  develop 
This  continues,  with  varying  degrees  of  severity,  f< 
a  month  or  six  weeks  until  its  paroxysms  cease  and 
simple  catarrhal  cough  ensues,  which  may  last  longe 

Whooping  cough  is  an  infectious  communicable  di 
ease. —  It  is  moderately  contagious  from  the  onset  ai 


WHOOPESTQ  COUGH  .  197 

materially  so  during  the  period  of  whoop.  It  is  taken 
by  inhaling  the  breath  from  one  sick  with  it,  but  more 
particularly  by  the  particles  of  spray  thrown  off  by 
them  in  coughing.  One  is  exposed  to  it  who  is  in 
such  proximity  as  to  be  within  range  of  this  ejected 
air  or  matter.  It  is  not  spread  readily  otherwise  in 
the  open  air.  While  there  is  some  reason  to  believe 
that  its  virus  may  be  harbored  in  rooms  and  clothing, 
it  is  not  probably  transported  thus,  nor  by  persons 
who  do  not  themselves  have  the  disease.  Those  who  are 
in  the  house  with  the  patient  are  most  likely  to  take  it. 
As  with  other  like  diseases,  one  attack  confers  im- 
munity and  adults  are  less  likely  to  contract  it  than 
children,  though  with  them  it  is  no  less  distressing, 
nor  less  apt  to  be  followed  by  secondary  complications. 

How  Whooping   Cough  may  be   Prevented 

This  can  only  be  done  by  isolating  those  who  have  it. 
This  is  often  regarded  as  impossible,  for  the  course 
of  the  disease  is  long  and  the  subjects  for  the  most 
part  are  able  to  be  about.  But  the  necessary  measures 
are  not  diflBcult.  The  child  need  not  be  shut  away 
in  a  room  or  house,  which  will  indeed  be  a  hardship 
for  so  long  lasting  a  disease  and  would  be  detrimental 
to  its  interests,  since  uncomplicated  cases  do  better 
generally  by  being  much  in  the  open  air.  The  child 
must  be  kept  from  school,  from  all  assemblages  of 
people  and  from  coming  in  contact  with  any  person  so 
as  to  expose  him  to  infection.  This  necessary  avoidance 
of  all  outside  the  family  can  be  taught  to  the  child, 
and  by  compliance  with  it  he  may  be  allowed  in  open 
yards  and  retired  streets.  It  would  be  very  well  to 
warn  the  public  against  entrance  into  the  house  where 
there  is  a  case  of  whooping  cough,  by  a  notice  posted 
on  the  door.  A  more  practical  procedure  is  to  placard 
the  child  himself  by  a   designating  mark,   such   as   a 


198  PUBI-IC   HEALTH   MANUAL 

sufficieutly  distinctive  ribbon  or  badge,  which  will 
warn  the  public  and  also  be  a  reminder  to  the  child 
not  to  mingle  at  close  range  with  others.  Observing 
proper  precautions,  a  subject  of  whooping  cough  can 
be  allowed  at  large  with  a  very  considerable  liberty; 
otherwise  he  should  be  compelled  to  submit  to  isolation 
at  home. 

Parents  should  never  voluntarily  expose  a  child  to 
whooping  cough.  Besides  there  is  a  fair  probability 
that  if  one  escapes  the  disease  in  childhood  he  may 
not  take  it  in  later  life.  School  teachers  should  ex- 
clude children  with  whooping  cough  from  schools  of  all 
kinds.  The  control  of  the  disease  lies  largely  with  the 
parent  and  school  oflBcers.  Boards  of  health  can  and 
should  enforce  the  preventive  measures. 


OPHTHAJinA   XEO:sATOEUiI  199 

OPHTHALMIA  NEONATORUM 

(Sore  Eves  of  Xew-Born  Babies) 

The  disease. —  This  disease  is  always  due  to  an  infec- 
tion caused  by  the  entrance  of  certain  germs  into  the 
ey€S  of  the  baby  at  the  time  of  or  shortly  after  birth. 

Its  prevention. —  The  disease  can  almost  surely  be 
prevented  by  the  exercise  of  proper  care  at  the  time  of 
birth  of  the  child  and  during  the  first  few  days  of  its 
life.  If  the  proper  precautions  are  not  taken,  and  the 
disease  develops  and  runs  its  course  unchecked,  the  sight 
is  totally  destroyed   often  within  a  fortnight. 

Its  extent. —  More  than  six  hundred  (600)  of  the  six 
thousand  (6,000)  blind  persons  in  the  State  of  Xew 
York  are  in  this  deplorable  condition  because  of  this 
disease. 

Through  negligence  it  has  caused  the  blindness  of  one- 
quarter  of  the  children  in  the  schools  for  the  blind. 

A  birth  infection  of  the  eyes,  is  almost  always  pre- 
ventable and  curable. 

Keep  the  infected  material  out  of  the  baby's  eyes  and 
then  use  the  preventive  solution. 

Distribution  of  Preventive  Solution 

The  State  Department  of  Health  furnishes  the  prophy- 
lactic solution  recognized  as  an  almost  certain  preventive 
agent  for  this  disease  under  the  following  conditions: 

Outfits. —  Outfits  have  been  prepared  containing  the 
following:  A  small  vial  holding  an  amount  of  a  one 
per  cent,  solution  of  nitrate  of  silver  su£B.cient  for  use 
on  one  new-born  child;  a  sterilized  dropper  and  bulb 
especially   adapted   for  making  the  application  of  this 


200  PUBLIC   HEALTH   MANUAL 

solution;    and   the  necessary   directions  for   the  use  of 
the  preventive  agent.  •  i 

General  distribution. —  These  outfits  will  be  sent  to 
the  health  officers  of  the  cities,  villages  and  towns 
throughout  the  State,  and  can  be  obtained  by  any  phy- 
sician from  these  officials  without  charge. 

Local  distributions. —  Health  officers  should  make 
requisition  upon  the  State  Department  of  Health  for  a 
sufficient  number  of  outfits  to  supply,  for  several  months, 
the  medical  profession  and  midwives  located  within  their 
jurisdiction.  It  is  intended  that  every  physician  and 
midwife  should  ha^ve  at  all  times  at  least  one  of  these 
outfits  in   their  obstetric  hags. 

Directions  for  mothers,  midwives  and  nurses. —  Leaf- 
lets of  instructions  are  supplied  by  the  Department  for 
those  having  immediate  care  of  the  new-born,  which 
contain    the   following   instructions    and   advice: 

Preventive  Measures  for  All  Mothers 

All  women  during  pregnancy  should  be  instructed  as 
follows:  Daily  external  cleansing  should  be  thoroughly 
performed  with  soap  and  water  and  a  clean  wash  cloth. 
Should  the  pregnant  woman  have  any  irritating  dis- 
charges, or  even  profuse  white  discharge,  she  should  be 
instructed  to  immediately  consult  her  physician  or  the 
nearest  dispensary. 

Preventive  Measures  for  All  Children  at  Birth 

Immediately  after  the  delivery  of  the  head,  before  the 
delivery  of  the  body,  the  eyelids  should  be  carefully 
cleaned  by  means  of  absorbent  cotton  or  a  soft  linen 
cloth  dipped  into  warm  water  that  has  been  boiled  or 


OPHTHALMIA   NEONATOBUM  201 

into  boric  acid  ( saturated )  solution.  A  separate  cloth 
should  be  used  for  each  eye,  and  the  lids  washed,  from 
the  nose  outward,  free  from  all  mucus,  blood  or  me- 
conium. These  cloths  should  be  burned  after  using.  No 
opening  of  the  lids  should  be  attempted  at  this  time. 
Also  the  lips  and  nose  should  be  in  like  manner  wiped 
free  of  mucus,  and  the  little  finger,  wrapped  with  a  piece 
of  moist  linen,  should  be  passed  into  the  child's  mouth 
and  any  accumulated  mucus  removed  by  an  outward 
sweep  of  the  finger. 


Use  of  Prophylactic  Solution 

(Supplied  Free  by  the  State  Department  of  Health) 

As  soon  after  birth  as  possible  the  eyelids  should  be 
again  wiped  clean  of  mucus,  and  two  drops  of  the  one 
per  cent,  solution  of  nitrate  of  silver  should  be  dropped 
into  each  eye.  One  application  only  of  the  silver  solu- 
tion should  he  made,  and  ordinarily  no  further  attention 
should  be  given  the  eyes  for  several  hours. 

Each  time  that  the  child  is  bathed,  the  eyes  should 
be  first  wiped  clean,  as  above  described,  with  the  boric 
acid  solution.*  The  hands  of  the  person  charged  with 
the  care  of  the  child  must  be  washed  with  soap  and 
dried  with  a  clean  towel  before  the  eyes  of  the  child  are 
touched.  Everything  that  is  brought  near  the  eyes  of 
the  child  must  be,  in  every  instance,  absolutely  clean. 

The  cotton  that  is  used  on  the  eyes  of  the  child  must, 
in  every  instance,  be  immediately  burned  after  it  is  used. 
The  water,  towels,  old  linen  and  the  cotton  that  have 
been  used  on  the  mother  must,  under  no  circumstances, 
be  applied  to  the  child. 


*  Boric  acid  costs  little  and  may  be  bought  of  any  druggist 
without  a  doctor's  prescription. 


202  PUBLIC    HEALTH    MANUAL 

What  Must  be  Done  When  Inflammation  of  the  Eyes 

Appears 

When  tlie  lids  become  red  aiid  swollen,  and  are 
gummed  along  their  borders,  and  when  mattery  dis- 
charge is  mixed  with  the  tears  as  the  child  sleeps  or 
cries,  a  physician  should  be  called  immediately,  or  the 
child  taken  to  the  nearest  dispensary.t  Each  hour  of 
the  delay  adds  to  the  danger.  \Miile  waiting  bathe  the 
eyes  of  the  child  every  half  hour  with  pledgets  of  cotton 
dipped  in  a  solution  of  boric  acid.  Open  the  lids  wide 
and  allow  the  solution,  which  should  be  warm,  to  flood 
the  eyes  and  wash  out  any  matter  which  may  have 
gathered  there. 

The  child  should  not  be  fondled  and  nothing  which 
has  been  used  about  the  eyes  or  face  should  be  used  for 
any  other  purpose.  All  of  those  in  the  home  should  be 
warned  of  the  danger  of  catehing  the  disease  by  getting 
the  matter  into  their  own  eyes.  Do  not  listen  to  those 
who  say  it  will  amount  to  nothing,  or  to  those  who 
say  to  bathe  the  eyes  of  the  child  with  the  mother's 
milk  (the  milk  is  a  means  of  spreading  the  germs  of 
this  disease).  Such  advice  is  bad;  the  delay  may  re- 
sult in  blindness. 


t  Physicians  and  others  having  knowledge  of  cases  of  ophthal- 
mia neonatorum  are  required,  under  the  provisions  of  chapter 
396  of  the  Laws  of  190S  to  report  the  same  to  the  health  officer 
of  city,  village  or  town  in  which  the  case  occurs. 


WATER   ANALYSIS  203 

WATER  ANALYSIS 

Conditions   Under   Which   Examinations   Are   Made 

It  will  be  the  policy  of  the  Department  to  make  ex- 
aminations of  samples  of  water  only  when  the  results 
of  such  examinations  are  directly  applicable  to  the  pre- 
vention of  disease  and  the  protection  of  public  health. 

For  the  present  all  public  water  supplies  will  be  con- 
sidered as  eligible  for  the  Department's  examinations. 

The  examination  of  individual  and  private  sources  of 
water  supply  cannot  be  undertaken  unless  some  public 
health  problem  is  involved.  It  will  not  be  considered 
necessary  to  make  examinations  of  samples  of  well 
waters  and  other  individual  sources  of  water  supply 
merely  because  of  the  existence  of  a  case,  or  cases,  of 
typhoid  fever  among  those  who  have  used  such  waters. 
If  after  all  other  more  likely  sources  of  infection  have 
been  carefully  considered  and  eliminated  and  a  well- 
founded  conclusion  that  the  disease  is  water-borne  is 
arrived  at,  an  examination  of  the  well  or  spring  water 
will  be  undertaken.      (See  diagram  on  page  205.) 

Xo  examination  can  be  made  of  water  samples  unless 
the  same  are  sent  by  a  local  health  officer,  or  by  his 
permission  or  order,  in  the  Department  container. 

The  carefully  prepared  directions  concerning  the  in- 
spection of  the  source  of  water,  the  method  of  collect- 
ing samples  and  the  details  of  packing  them,  which  are 
enclosed  in  each  outfit,  must  be  strictly  carried  out  by 
the  local  health  oflScer. 

In  all  cases  the  entire  outfit  must  be  returned  to  the 
laboratory  by  express.  Parts  of  the  same  should  not  be 
sent  in  through  the  mails. 

All  express  charges  on  the  outfits  must  be  paid  by 
the  local  authorities. 


204  PUBLIC  HEALTH   MANUAL 

Applications  for  outfits  should  expressly  state  the 
character  and  source  of  the  supply  to  be  examined  and 
the  reason  for  the  request  for  such  examination.  They 
should  be  addressed  to  the  State  Department  of  Health. 


WATER  EXAMINATIONS 

Their  Scope  in  the  Investigation  of  Typhoid  Infections 

Because  of  the  technical  difficulties,  it  is  impossible 
to  isolate  the  typhoid  bacillus  from  samples  of  water  as 
a  routine  procedure.  For  this  reason  the  aid  that  a 
water  analysis  can  give  in  the  determination  of  the 
source  of  infection  in  typhoid  fever  is  limited. 

The  regular  bacteriological  examination  of  a  sample 
of  water  consists  in  the  estimation  of  the  number  of 
bacteria  present  in  a  cubic  centimeter  of  the  sample, 
commonly  known  as  the  "  bacterial  count,"  and  the  de- 
termination of  the  presence  or  absence  and  the  relative 
prevalence  of  bacteria  of  the  bacillus  coli  communis 
type. 

The  "  bacterial  count "  gives  some  indication  of  the 
amount  of  pollution.  The  presence  of  large  numbers  of 
bacteria  shows  at  least  the  presence  of  plenty  of  organic 
food  for  them.  Organic  pollution  and  high  bacterial 
content  go  hand  in  hand. 

The  presence  of  the  hacillus  coU  communis  type  of 
bacteria  in  a  sample  is  indicative  of  the  character  of 
the  pollution.  These  organisms  have  as  their  natural 
habitat  the  intestinal  tracts  of  man  and  of  warm-blooded 
animals.  It  is  impossible  to  differentiate  between 
B.  coli  of  animal  and  human  origin,  and  the  positive 
results  should  not  be  interpreted  as  r.ecessarily  indicat- 
ing pollution  from  human  sources. 


WATEE  EXAMTNATIONS 


205 


The  laboratory  evidences,  derived  from  the  results  of 
our  examination,  merely  indicate  the  presence  or  absence 
of  pollution.  They  are  only  of  an  indirect  value  in  the 
investigation  of  typhoid  infections  and  should  not  be  re- 
lied upon  as  the  only  method  of  investigation  of  the 
causation  of  cases  of  this  disease.  This  is  particularly 
true  ji  cases  in  which  well  waters  are  frequently  sus- 
pected of  having  a  causative  relation  to  the  disease. 


A(tMii  of  etuiA 


Oriyln.^  ■toj^Ke*. 


O^i'ntU.   -tt/r-yct^^. 


There  is  but  little  evidence  that  well  waters  are  com- 
monly responsible  for  typhoid  outbreaks.  The  common 
sources  of  pollution  reaching  wells,  are  from  surface 
wash  and  percolation  through  the  soil. 

The  possibilities  of  such  pollution  from  surface  wash 
can  be  ascertained  by  inspection.    Many  excavated  wells 


206  PUBLIC  HEALTH   MANUAL 


are  subject  to  pollution  from  surface  wash  through 
leaky  walls  and  platforms,  and  much  of  this  pollution 
is  usually  from  animal  sources.  This  pollution  can  be 
prevented  by  making  the  walls  of  water-tight  material 
such  as  concrete,  for  about  six  feet  below  the  surface 
of  the  ground,  and  extending  the  wall  about  a  foot  and 
a  half  above  the  general  surface.  Filling  around  this 
wall  with  earth  will  form  a  mound  to  divert  surface 
wattr,  and  what  surface  water  does  reach  the  well 
will  first  have  to  percolate  through  at  least  six  feet  of 
soil,  thus  giving  an  opportunity  for  soil  filtration,  which 
is  an  efficient  method  of  purification.  Except  through 
fissured  rock  formations,  infections  of  wells  through 
sub- surface  percolation  is  probably  not  frequent. 

It  has  been  the  experience  of  the  Department  that  in 
the  majority  of  cases  the  cause  of  typhoid  infection 
should  be  attributed  to  a  source  other  than  the  well 
water,  and  efforts  should  be  made  to  trace  all  other 
sources  of  possible  infection  before  concluding  that  the 
well  is  the  probable  avenue  of  transmission. 


INDEX 


Animals,  disposal  of  dead,  114;  contagious  diseases  of,  140. 

Antitoxin,  132,  178. 

Annual  sanitary  conference,  17,  126,  128. 

B 

Births,  to  be  registered,  21;  to  be  reported,  model  regulations,  123; 
Board  of  Health  of  city,  representative  to  act  with  Cornmis- 
sioner,  10;  Board  of  Health  —  if  municipality  fails  to  establish, 
11;  law  for  establishment  of,  14;  membership  to  be  reported  to 
State  department  of  health,  17;  as  to  health  officer,  17;  powers 
and  duties,  17;  may  issue  subpoena,  18;  warrants  to  sheriff,  19; 
to  make  regulations,  18;  as  to  sewers,  19;  vital  statistics,  20; 
burial  permits,  22;  transportation  of  dead  bodies,  23;  com- 
mimicable  diseases,  24;  to  report  same  to  State  department  of 
health,  24;  vaccine  virus  and  vaccination  to  be  provided,  25; 
nuisances,  26;  removal  of  same,  30;  expense  of  removal,  31; 
to  take  definite  action  directed  by  State  Department  of  Health, 
26;  as  to  mosquitos,  26;  to  control  manufactures  in  tenement- 
houses,  32;  jurisdiction  of  town  and  village  boards  of  health, 
33;  combined  sanitary  district,  34;  expenses  paid,  34;  may 
enforce  authority  by  mandamus,  35;  control  of  noxious  trades, 
36;  to  enforce  water  supply  rules,  39,  48;  to  investigate  com- 
plaints against  management  of  institutions,  55;  as  to  control 
of  tuberculosis,  63;  penalty  for  violation  of  regulations,  Penal 
Code,  77;  model  regulations,  109. 

Books  from  library  in  infected  houses,  120. 

Burial  permits,  22,  granted  by,  22;  required,  22,  124. 


Canals,  overflow  from,  as  cause  of  sickness,  9. 

Cemetery,  regulating  interments  in,  23;  keepers  and  sextons,  124, 

Cerebrospinal  meningitis,  circular  of  instruction,  180. 

Cesspools,  regulation  of,  109. 

Children's  institutions,  care  of,  54. 

Combined  sanitary  districts,  34. 

Communicable  diseases,  duty  of  board  of  nealth,  24;  to  be  re- 
ported, 24,  115;  in  county  almshouse,  25;  in  workshops,  32; 
penalty  for  exposing,  78;  list  of  reportable,  111,  129;  quarantine 
of,  111;  importation  of,  prohibited,  119;  funerals  of,  121;  in 
schools,  135;  circulars  of  instruction  on,  153. 

Ziounty  hospitals  for  tuberculosis,  law,  67. 

Dulture  tubes,  133. 


208  INDEX 


D 


Dead,  transportation  of,  regulated,  146. 

Deaths  to  be  certified  as  to  cause,  21,  124;  to  be  registered,  21. 

Diphtheria,  circular  of  instruction,  175. 


Factories,  waste  from,  43,  44,  49. 

Fat-rendering  establishments  prohibited,  38;    regulation  of,  113. 
Fertilizers,  manufacture  of,  regulated,  36. 

Food,  exposure  to  contamination   (model  regulations),  114;  un- 
wholesome offered  for  sale,  113:  exposure  to  flies,  114. 
Funerals  and  infectious  diseases,  115. 

G 

Garbage  disposal,  111. 

H 

Health  laws  and  regulations,  penalty  for  violation  of,  77. 

Health  officer,  appointment  of,  16;  term  of  office,  16;  removal 
from  office,  16;  residence,  16;  duties  prescribed  by  board  of 
health,  17;  compensation  and  expenses,  17;  executive  officer  of 
board  of  health,  17,  128;  to  fill  out  certificate  of  death,  21;  to 
report  to  State  depanment  of  health,  24;  tuberculosis  disin- 
fection, 60;  examination  of  sputum,  59;  control  of  tuberculous 
person,  62;  penalty  for  obstructing.  Penal  Code,  78;  com- 
municable diseases  to  be  reported  to,  115;  quarantine  enforced 
by,  117;  library  books  from  infected  houses,  120;  duties  and 
powers,  model  regulations,  125;  instructions  to  (department), 
128;  as  to  rabies,  136;  care  of  insane,  136;  employment  of 
minors,  139;  circular  of  instruction  to,  128. 

Hospitals  for  tuberculosis,  56. 


Ice  from  contaminated  source,  li4. 

Indians,  relief  in  epidemics,  35. 

Infectious  diseases  (see  communicable  diseases),  21;    of  animals, 

140. 
Insane,  care  of,  by  health  officers,  136. 
Institutions  for  destitute  children,  54. 
Instructions  to  health  officers,  128;  to  registrars,  143. 
Interment  in  cemeteries  regulated,  22,  23. 

L 
Land,  acquisition  of,  for  quarantine  in  emergency,  11. 


tNDEX  20S 


M 


Measles,  circular  of  instruction,  190. 

Medical  officers  of  department  of  health,  4, 

Minors,  employment  of,  139. 

Model  regulations,  for  boards  of  health,  adoption,  109. 

Mosquito  extermination,  27;  cost  of,  assessed,  26. 

Municipality  to  establish  boards  of  health,  14;    failure  to  do  sa 

11;  defined,  17;  may  protect  water  supply,  50. 
Mandamus  to  enforce  Public  Health  Law,  35. 


N 

Notification  of  communicable  diseases,  115;  required,  of  physi- 
cians,  24,   116. 

Noxious  trades,  36;  model  regulations  on,  112,  113. 

Nuisance,  defined,  77,  109:  power  of  State  commissioner  of  health 
in,  8,  10;  of  local  board*  of  health  in,  26,  30;  expense  of  removal, 
30;  penalty  for  maintaining  under  Penal  Law,  77;  instructiong 
to  health  officer  regarding,    125,  131. 

O 

Officers  of  State  department  of  health,  3;  compensation,  6. 
Ophthalmia  neonatorum,  circular  of  instruction,  134,  199. 
Orphan  asylums,  care  of,  54. 

P 

Penal  Law,  the,  77. 

Penalty  for  violation  of  Health  Law,  65,  66,  77;  for  violation  of 
board  of  health  regulations,  19,  127;  for  discharge  of  sewage 
into  waters  of  State,  49. 

Pig-pens  and  chicken  yards,  regulation  of,  110. 

Physicians  to  report  commimicable  diseases,  24,  115;  compensa- 
tion for  same,  24;  list  of  diseases  to  be  so  reported,  116. 

Potable  waters  law,  37;   regulations  of  the  department  for,  37. 

Privy-pits,  regulation  of,  109. 

Public  Health  Law,  5;  exemptions  from,  35, 

Public  works,  examined  by  State  commissioner  of  health,  10, 

Q 

Quarantine,  acquisition  of    land  for,  in  emergency,  11;    model 
regulations  on,  117;  degrees  of,  117;  of  infectious  animals,  121; 
instructions  to  health  officers  on,  130. 
U 


210  INDEX 


R 


Rabies,  treatment  of,  at  Pasteur  institute,  136;  health  oflBcer's 
action,  136. 

Regulations  of  board  of  health,  IS;  model,  109;  of  State  depart- 
ment of  health  for  transportation  of  corpse,  146. 

Registration  of  births  and  deaths,  20;  costs  of,  21. 

Rendering  establishments,  36,  113;  model  regulation  regarding, 
113. 

S 

Sanitary  regulations,  model  for  boards  of  health,  109. 

Scarlet  fever,  circular  of  instruction,  190. 

School — testing  eyesight  of  pupils,  134;  vaccination,  53,  135, 
169;  communicable  diseases  in,  135;  tuberculosis  in,  157; 
teachers  help  to  control  disease,  195;  officers  to  enforce  vaccin- 
ation law,  53,  135. 

Sewerage,  protection  of  water  supply  frQm,  40,  49;  penalty  for 
discharge  of,  49;    systems,  rules  of  department,  ICO. 

Sewers,  board  of  health  authority  with,  19;  Village  Law  on,  79; 
Town  Law  on,  88;  plans  for  system  of,  100;  plans  for,  to  be 
submitted  to  State  department  of  health,  79,  91;  house  sewers, 
111. 

Slaughter-houses,  114. 

Smallpox,  circular  of  instruction,  167. 

Spitting  controlled,  62,  155;  model  regulations  on,  120. 

Sputum  examinations,  59,  155. 

Stable,  regulation,  110. 

State  board  of  health  defined,  13. 

State  commissioner  of  health,  3,  5;  powers  and  duties,  6;  may 
exercise  powers  of  local  board  of  health,  11;  in  State  institu- 
tions, 12;  may  make  rules  as  to  care  of  epidemics  among 
Indians,  35;  protection  of  potable  waters,  37;  site  of  tubercu- 
losis camps  and  hospitals,  56;  sewerage  system  plans,  79,  91, 
ICO. 

State  Department  of  Health,  established,  5;  may  direct  definite 
action  by  board  of  health,  26;  may  enforce  by  mandamus,  35; 
water  supply  rules,  37;  may  take  action  to  enforce  same,  39; 
sewer  system  plans,  79;   co-operation  with  health  officers,  141. 

State  institutions,  sanitary  plans  and  conditions  supervised,  12. 

Subpoena  issued  by  State  commissioner  of  health,  7;  by  boards 
of  health,  18. 

Superintendents  of  institutions  to  report  contagious  diseases,  12. 

SuppUes  furnished,  132,  133,  138. 

Susquehanna  river  protected  from  sewerage,  42. 

Swamps  drained,  28;  costs  of  assessed,  29;  access  to  through 
other  lands,  29. 


INDEX  211 


Tenement-houses,  enforcement  of  laws  relating  to,  12;  contiol  of 
manufactures  in,  33;  communicable  diseases  in,  33. 

Town  law  establishing  sewer  system,  88. 

Transportation  permits,  of  corpse,  23;  regulations  for,  146. 

Transit  permits,  124,  128,  150. 

Tuberculosis,  cases  to  be  reported,  58,  115,  129;  law  regarding, 
58;  camps  and  hospitals,  56,  67;  health  oflBcer  in,  133;  circular 
of  Instruction,  133;  campaign  of  education  in,  153,  157. 

Typhoid  fever,  circular  of  instruction,  159. 


Vaccination  to  be  provided  by  board  of  health,  25;  of  school 
children,  53,  135;  directions  regarding  to  health  officers,  169; 
care  of,  170, 

Vaccine  virus,  suppUes  to  be  kept  by  board  of  health,  25. 

Village  board  of  health,  may  combine  with  town  board,  34;  Vil- 
lage Law  on  establishing  sewers,  79. 

Vital  statistics — State  department  of  health,  7;  local  boards  of 
health,  20;  health  officers,  128;  registrars,  143, 

W 

Warrants  Issued  to  sheriff  and  constable  by  board  of  health,  19. 
Water  analysis,  in  typhoid  fever,    164;    directions  for  securing, 

203;  examinations,  204. 
Water  supplies,  protection  of,  37,  40,  49. 
Whooping  cough,  circular  of  information,  196. 
Widal  outfits,  133,  162. 


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